Provider Demographics
NPI:1255997102
Name:LOLYS PHARMACY INC
Entity type:Organization
Organization Name:LOLYS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANABERLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCOSME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-727-6315
Mailing Address - Street 1:21 W 183RD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-1233
Mailing Address - Country:US
Mailing Address - Phone:917-737-8253
Mailing Address - Fax:917-737-8255
Practice Address - Street 1:21 W 183RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-1233
Practice Address - Country:US
Practice Address - Phone:917-737-8253
Practice Address - Fax:917-737-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy