Provider Demographics
NPI:1891899431
Name:LUMIT RX INC
Entity Type:Organization
Organization Name:LUMIT RX INC
Other - Org Name:LUMIT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RAVIKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMIDELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-866-0629
Mailing Address - Street 1:200 E 167TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-4004
Mailing Address - Country:US
Mailing Address - Phone:718-866-0629
Mailing Address - Fax:718-866-0630
Practice Address - Street 1:200 E 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-4004
Practice Address - Country:US
Practice Address - Phone:718-866-0629
Practice Address - Fax:718-866-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0288383336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2064390OtherPK
NY02958170Medicaid