Provider Demographics
NPI:1922105857
Name:LINCOLN PLACE PHARMACY INC
Entity Type:Organization
Organization Name:LINCOLN PLACE PHARMACY INC
Other - Org Name:LINCOLN PLACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YAWER
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-756-1717
Mailing Address - Street 1:1135 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4107
Mailing Address - Country:US
Mailing Address - Phone:718-756-1717
Mailing Address - Fax:718-604-1400
Practice Address - Street 1:1135 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4107
Practice Address - Country:US
Practice Address - Phone:718-756-1717
Practice Address - Fax:718-604-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0234403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02269634Medicaid
2058914OtherPK