Provider Demographics
NPI:1730281072
Name:LM DRUG CORP
Entity Type:Organization
Organization Name:LM DRUG CORP
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAUMANDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-292-8200
Mailing Address - Street 1:1987 STATE ROUTE 52
Mailing Address - Street 2:STE 3
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-8316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1987 STATE ROUTE 52
Practice Address - Street 2:STE 3
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-8316
Practice Address - Country:US
Practice Address - Phone:845-292-8200
Practice Address - Fax:845-292-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024129333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3300718OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY01880244Medicaid
NYBT6029323OtherDEA #
3300718OtherOTHER ID NUMBER-COMMERCIAL NUMBER