Provider Demographics
NPI:1679023915
Name:LYONS PHARMACY
Entity Type:Organization
Organization Name:LYONS PHARMACY
Other - Org Name:LYONS PHARMACY DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:SO YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:646-633-3950
Mailing Address - Street 1:471 LYONS AVE #79
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111
Mailing Address - Country:US
Mailing Address - Phone:973-926-6496
Mailing Address - Fax:973-926-6467
Practice Address - Street 1:471 LYONS AVE #79
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-926-6496
Practice Address - Fax:973-926-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007515003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164545OtherPK