Provider Demographics
NPI:1558195024
Name:LUMEN PHARMACY INC
Entity type:Organization
Organization Name:LUMEN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWADALLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:718-310-6120
Mailing Address - Street 1:6242 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1929
Mailing Address - Country:US
Mailing Address - Phone:718-310-6120
Mailing Address - Fax:888-518-5120
Practice Address - Street 1:6242 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1929
Practice Address - Country:US
Practice Address - Phone:718-310-6120
Practice Address - Fax:888-518-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy