| NPI | 1437824117 |
|---|---|
| Doing Business As | LAKE AVE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | JACQUELINE BISSAH Supervising Pharmacist 914-965-3034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2022-02-25 |