Provider Demographics
NPI:1558680827
Name:LURIE, MILTON J
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:J
Last Name:LURIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 246TH ST
Mailing Address - Street 2:APT 507
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3611
Mailing Address - Country:US
Mailing Address - Phone:203-676-5351
Mailing Address - Fax:
Practice Address - Street 1:600 W 246TH ST
Practice Address - Street 2:APT 507
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3611
Practice Address - Country:US
Practice Address - Phone:203-676-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053206-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist