Provider Demographics
NPI:1891140489
Name:LALIBELA, LTD
Entity Type:Organization
Organization Name:LALIBELA, LTD
Other - Org Name:ELITE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:BEREZHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-226-6896
Mailing Address - Street 1:9892 BUSTLETON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2138
Mailing Address - Country:US
Mailing Address - Phone:267-939-8449
Mailing Address - Fax:215-560-8996
Practice Address - Street 1:9892 BUSTLETON AVE STE 102
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2138
Practice Address - Country:US
Practice Address - Phone:215-315-8980
Practice Address - Fax:215-315-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4826403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy