Provider Demographics
NPI:1750466967
Name:133 DRUG CORP
Entity Type:Organization
Organization Name:133 DRUG CORP
Other - Org Name:LAKEVIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:V
Authorized Official - Last Name:FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-599-4646
Mailing Address - Street 1:133 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1742
Mailing Address - Country:US
Mailing Address - Phone:516-599-4646
Mailing Address - Fax:516-599-6383
Practice Address - Street 1:133 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1742
Practice Address - Country:US
Practice Address - Phone:516-599-4646
Practice Address - Fax:516-599-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00383028Medicaid
0641740001Medicare ID - Type Unspecified