Organization Active NPI

Lydig Avenue Pharmacy Corp

  • Pharmacy
  • Bronx, NY
National Provider Identifier
1396750907
Registry record updated Aug 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
026027 Issued in NY
Legal business name
LYDIG AVENUE PHARMACY CORP
Doing business as
LYDIG AVENUE PHARMACY CORP
Practice address
742 Lydig Ave
Bronx, NY 10462-2104
Phone
(718) 678-8700
Fax
(718) 678-8777
NPI assigned
Jul 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2011

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

Authorized official

Name
Muhammad Abid Javaid
Title
Pharmacist
Phone
(718) 678-8700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 026027 NY Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

742 Lydig Ave
Bronx, NY 10462-2104

Mailing address

742 Lydig Ave
Bronx, NY 10462-2104

Other identifiers 2

IdentifierTypeStateIssuer
3332688OtherOTHER ID NUMBER-COMMERCIAL NUMBER
02397304MedicaidNY

Other names 1

  • LYDIG AVENUE PHARMACY CORP Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313712000000",
    "number": "1396750907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 LYDIG AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104622104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 LYDIG AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104622104",
            "telephone_number": "718-678-8700",
            "fax_number": "718-678-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYDIG AVENUE PHARMACY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2011-08-19",
        "status": "A",
        "authorized_official_last_name": "JAVAID",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_middle_name": "ABID",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "718-678-8700"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "026027",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3332688",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02397304",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LYDIG AVENUE PHARMACY CORP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2011; 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.