Provider Demographics
NPI:1790217891
Name:FUSION APOTHECARY LCC
Entity type:Organization
Organization Name:FUSION APOTHECARY LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPIR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:1917-472-7895
Mailing Address - Street 1:1158 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8504
Mailing Address - Country:US
Mailing Address - Phone:191-747-2789
Mailing Address - Fax:
Practice Address - Street 1:1158 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8504
Practice Address - Country:US
Practice Address - Phone:191-747-2789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0347643336S0011X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy