Provider Demographics
NPI:1780082339
Name:LEXANN PHARMACY & WELLNESS CENTER
Entity type:Organization
Organization Name:LEXANN PHARMACY & WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:OWOLABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-678-1700
Mailing Address - Street 1:1885 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3419
Mailing Address - Country:US
Mailing Address - Phone:973-763-0010
Mailing Address - Fax:973-763-0009
Practice Address - Street 1:1885 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3419
Practice Address - Country:US
Practice Address - Phone:973-763-0010
Practice Address - Fax:973-763-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007375003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148686OtherPK
NJ7326250001Medicare NSC