Lifesource Plus Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

031093 Issued in NY

Legal business name

LIFESOURCE PLUS INC

Practice address

8514 Queens Blvd
Elmhurst, NY 11373-4249

Phone

(718) 803-8393

NPI assigned

Jan 30, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Crystal WongNPI 1518246248

Title

President

Phone

(718) 803-8393

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Lifesource Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Crystal Wong, PHARMD

  • Pharmacist
  • Elmhurst, NY
  • NPI 1518246248
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336089600000",
    "number": "1366714974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8514 QUEENS BLVD",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734249",
            "telephone_number": "718-803-8393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8514 QUEENS BLVD",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734249",
            "telephone_number": "718-803-8393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESOURCE PLUS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-30",
        "last_updated": "2012-05-04",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-803-8393"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "031093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5804314",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifesource Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Regina Lichtsztral, M.D.
• Joseph J. Lieber, M.D.
• Laurie Lieberman, LMSW
• Ronni M. Lieberman, M.D.
• Talia Liebman
• Lily Early Intervention LLC
• Haydee Loo Lim
• Jong Lim, D.D.S.
• Lucy Lim, M.D.
• Yeong-Yeong Lim, NP

• Community/Retail Pharmacy in Elmhurst, NY
• Providers in Elmhurst, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.