Provider Demographics
NPI:1215161393
Name:LEXANN PHARMACY. LLC
Entity type:Organization
Organization Name:LEXANN PHARMACY. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:OLUSOJI
Authorized Official - Last Name:OWOLABI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:973-678-1700
Mailing Address - Street 1:333 CENTRAL AVE # 335
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2801
Mailing Address - Country:US
Mailing Address - Phone:973-678-1700
Mailing Address - Fax:
Practice Address - Street 1:333-335 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-678-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6424900001Medicare NSC