Organization Active NPI

Lumit RX Inc

Doing business as Lumit Pharmacy

  • Community/Retail Pharmacy
  • Bronx, NY
National Provider Identifier
1891899431
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
028838 Issued in NY
Legal business name
LUMIT RX INC
Doing business as
Lumit Pharmacy
Practice address
200 E 167TH St
Bronx, NY 10456-4004
Phone
(718) 866-0629
Fax
(718) 866-0630
NPI assigned
Sep 12, 2006
Last updated
Sep 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Authorized official

Name
Ravikumar MamidelaNPI 1396926051
Title
President/Supervising Pharmacist
Phone
(718) 866-0629

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 028838 NY Primary

Addresses

Primary practice location

200 E 167TH St
Bronx, NY 10456-4004

Mailing address

200 E 167TH St
Bronx, NY 10456-4004
Phone (718) 866-0629

Other identifiers 2

IdentifierTypeStateIssuer
2064390OtherPK
02958170MedicaidNY

Other names 1

  • LUMIT PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930011821 NY DME Supplier - Pharmacy 5799981676 Practice locations: Bronx, NY
O20210706002629 NY Part B Supplier - Mass Immunization (Roster Biller Only) 5799981676 Practice locations: Bronx, 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
Lumit RX Inc200 E 167TH St, Bronx, NY 10456-4004(718) 866-0629 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Does not accept assignmentParticipating since Apr 23, 2008

National Provider Directory

National Provider Directory

Locations

200 E 167th St
Bronx, NY 10456
Phone (718) 866-0629

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630627200000",
    "number": "1891899431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 167TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104564004",
            "telephone_number": "718-866-0629",
            "fax_number": "718-866-0630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E 167TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104564004",
            "telephone_number": "718-866-0629",
            "fax_number": "718-866-0630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMIT RX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A",
        "authorized_official_last_name": "MAMIDELA",
        "authorized_official_first_name": "RAVIKUMAR",
        "authorized_official_title_or_position": "PRESIDENT/SUPERVISING PHARMACIST",
        "authorized_official_telephone_number": "718-866-0629"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "028838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2064390",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02958170",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LUMIT PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LUMIT PHARMACY",
            "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 Sep 3, 2021; 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.