Provider Demographics
NPI:1790320752
Name:LUCIA'S PHARMACY INC.
Entity Type:Organization
Organization Name:LUCIA'S PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ELKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-830-0600
Mailing Address - Street 1:2090 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3423
Mailing Address - Country:US
Mailing Address - Phone:917-830-0600
Mailing Address - Fax:917-830-0636
Practice Address - Street 1:2090 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3423
Practice Address - Country:US
Practice Address - Phone:917-830-0600
Practice Address - Fax:917-830-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy