Provider Demographics
NPI:1952440901
Name:1491 LEX PHARMACY INC
Entity Type:Organization
Organization Name:1491 LEX PHARMACY INC
Other - Org Name:LEXINGTON AVENUE CHEMISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LIZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZARIO
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:212-289-3665
Mailing Address - Street 1:1491 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-289-3665
Mailing Address - Fax:212-289-3995
Practice Address - Street 1:1491 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-289-3665
Practice Address - Fax:212-289-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027656333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02732603Medicaid
NY02732603Medicaid