Provider Demographics
NPI:1912475229
Name:LVRX LLC
Entity Type:Organization
Organization Name:LVRX LLC
Other - Org Name:LVRX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-288-8584
Mailing Address - Street 1:211 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1205
Mailing Address - Country:US
Mailing Address - Phone:724-995-8868
Mailing Address - Fax:724-995-8870
Practice Address - Street 1:211 S MARKET ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1205
Practice Address - Country:US
Practice Address - Phone:814-288-8584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103589987-0001Medicaid