Provider Demographics
NPI:1861430969
Name:LABAINC D/B/A ALY MARC PHARMACY
Entity type:Organization
Organization Name:LABAINC D/B/A ALY MARC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:PH
Authorized Official - Phone:718-291-1845
Mailing Address - Street 1:17941 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4631
Mailing Address - Country:US
Mailing Address - Phone:718-291-1845
Mailing Address - Fax:718-291-5606
Practice Address - Street 1:17941 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4631
Practice Address - Country:US
Practice Address - Phone:718-291-1845
Practice Address - Fax:718-291-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01513446Medicaid
NY5144750001Medicare NSC