Provider Demographics
NPI:1538718002
Name:LO NG PHARMACY CORP
Entity type:Organization
Organization Name:LO NG PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:OR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-886-6200
Mailing Address - Street 1:44-45A KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3055
Mailing Address - Country:US
Mailing Address - Phone:718-886-6200
Mailing Address - Fax:718-886-6687
Practice Address - Street 1:44-45A KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3055
Practice Address - Country:US
Practice Address - Phone:718-886-6200
Practice Address - Fax:718-886-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-08
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY609858320OtherDRIVER LICENSE