Provider Demographics
NPI:1053609354
Name:LSH EXPRESS INC
Entity type:Organization
Organization Name:LSH EXPRESS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FATAKHOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-997-7444
Mailing Address - Street 1:9914 63RD RD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1940
Mailing Address - Country:US
Mailing Address - Phone:718-997-7444
Mailing Address - Fax:718-997-7445
Practice Address - Street 1:9914 63RD RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1940
Practice Address - Country:US
Practice Address - Phone:718-997-7444
Practice Address - Fax:718-997-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0307503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5802942OtherNCPDP PROVIDER IDENTIFICATION NUMBER
6606730001Medicare NSC