Provider Demographics
NPI:1982648739
Name:LI EZRA APOTHECARY LTD
Entity Type:Organization
Organization Name:LI EZRA APOTHECARY LTD
Other - Org Name:EZRA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES /SUPERVISING PHARM
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGWEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-569-7820
Mailing Address - Street 1:690 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2307
Mailing Address - Country:US
Mailing Address - Phone:516-569-7820
Mailing Address - Fax:516-569-0832
Practice Address - Street 1:690 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2307
Practice Address - Country:US
Practice Address - Phone:516-569-7820
Practice Address - Fax:516-569-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0195773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065112OtherPK
NY01076993Medicaid
3390779OtherNCPDP
0849280001OtherDME/MEDICARE
0849280001Medicare NSC