Provider Demographics
NPI:1760469308
Name:L. FERNANDEZ FARMACIA, INC
Entity Type:Organization
Organization Name:L. FERNANDEZ FARMACIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-738-0500
Mailing Address - Street 1:12323 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2115
Mailing Address - Country:US
Mailing Address - Phone:718-738-0500
Mailing Address - Fax:718-738-5327
Practice Address - Street 1:12323 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2115
Practice Address - Country:US
Practice Address - Phone:718-738-0500
Practice Address - Fax:718-738-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019142333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01177962Medicaid
NY5555980001Medicare ID - Type Unspecified