Provider Demographics
NPI:1912077215
Name:L&J PHARMACY, INC.
Entity Type:Organization
Organization Name:L&J PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIBEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:914-963-3346
Mailing Address - Street 1:81 HAYWARD ST
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1805
Mailing Address - Country:US
Mailing Address - Phone:914-963-3346
Mailing Address - Fax:914-963-0362
Practice Address - Street 1:284 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-2026
Practice Address - Country:US
Practice Address - Phone:914-963-3346
Practice Address - Fax:914-963-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0168223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00525599Medicaid
NY00525599Medicaid
NY5218400001Medicare ID - Type Unspecified