Lake Ave Pharma LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

LAKE AVE PHARMA LLC

Doing business as

Lake Ave Pharmacy

Practice address

130 Lake Ave
Yonkers, NY 10703-2713

Phone

(914) 965-3034

Fax

(914) 965-4176

NPI assigned

Aug 13, 2021

Last updated

Feb 25, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jacqueline Bissah

Title

Supervising Pharmacist

Phone

(914) 965-3034

Specialties & licenses 1

Addresses

Other names 1

• LAKE AVE PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Lupo, RPH

  • Pharmacist
  • Yonkers, NY
  • NPI 1073773222
  NPD (past)

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

{
    "created_epoch": "1628812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645747200000",
    "number": "1437824117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 LAKE AVE",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107032713",
            "telephone_number": "914-965-3034",
            "fax_number": "914-965-4176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 LAKE AVE",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107032713",
            "telephone_number": "914-965-3034",
            "fax_number": "914-965-4176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE AVE PHARMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-13",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A",
        "authorized_official_last_name": "BISSAH",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "SUPERVISING PHARMACIST",
        "authorized_official_telephone_number": "914-965-3034"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE AVE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LAKE AVE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vasilios K. Lagos, PSY.D.
• Lea Lagreca
• Emily Laguardia, CCC-SLP
• Valentina Lajqi, FNP
• Lake Ave Medical Transportation Inc (Lake Ave. Medical Transportaion INC)
• Lake Ave Pharmacy Inc
• Priyanka Lalakia, PT
• Adhalia R Lalchandani, DC
• Candice L Lalima
• Rodelie Lalime

• Community/Retail Pharmacy in Yonkers, NY
• Providers in Yonkers, 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 Feb 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.