Organization Active NPI

Lucia's Pharmacy Inc.

  • Community/Retail Pharmacy
  • Staten Island, NY
National Provider Identifier
1790320752
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
LUCIA'S PHARMACY INC.
Practice address
2090 Hylan Blvd
Staten Island, NY 10306-3423
Phone
(917) 830-0600
Fax
(917) 830-0126
NPI assigned
Nov 14, 2019
Last updated
Jun 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Authorized official

Name
Michael John Elkhoury
Title
President
Phone
(917) 830-0600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

2090 Hylan Blvd
Staten Island, NY 10306-3423

Mailing address

2090 Hylan Blvd
Staten Island, NY 10306-3423
Phone (917) 830-0600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20200320002711 NY DME Supplier - Pharmacy 6800224049 Practice locations: Staten Island, NY
O20210210000553 NY Part B Supplier - Mass Immunization (Roster Biller Only) 6800224049 Practice locations: Staten Island, NY
O20260430002381 NY Part B Supplier - Pharmacy 6800224049 Practice locations: Staten Island, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Lucia's Pharmacy Inc.2090 Hylan Blvd, Staten Island, NY 10306-3423(917) 830-0600 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Enteral Nutrients Accepts assignmentParticipating since Jan 1, 2022

National Provider Directory

National Provider Directory

Locations

2090 Hylan Blvd
Staten Island, NY 10306
Phone (718) 351-0616

Practitioners & affiliated clinicians

Practitioners 37

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.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1790320752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2090 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103063423",
            "telephone_number": "917-830-0600",
            "fax_number": "917-830-0636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103063423",
            "telephone_number": "917-830-0600",
            "fax_number": "917-830-0126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCIA'S PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-14",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "ELKHOURY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-830-0600"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.