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LAKE AVE PHARMACY
NPI 1437824117
Pharmacy - Community/Retail Pharmacy in Yonkers, NY

Active since August 13, 2021
130 LAKE AVE, YONKERS, NY 10703(914) 965-3034(914) 965-4176 Get Directions Write a Review

NPPES record last updated: February 25, 2022. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Feb 25, 2022, Aug 13, 2021 (2 updates tracked since 2021).

About Lake Ave Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE AVE PHARMACY (NPI 1437824117) is a healthcare organization registered as a community/retail pharmacy in Yonkers, New York and active in the NPI registry since August 2021. The organization lists Jacqueline Bissah, Supervising Pharmacist, as its authorized official.

NPPES Registry Identity

NPI1437824117
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameLAKE AVE PHARMA LLC
Location Address130 LAKE AVEYonkers, NY 10703-2713
Mailing Address130 Lake AveYonkers, NY 10703-2713 · (914) 965-3034 · Fax (914) 965-4176
Phone(914) 965-3034
Fax(914) 965-4176
Organization SubpartNo
Authorized OfficialJacqueline BissahSupervising Pharmacist · (914) 965-3034
Enumeration DateAugust 13, 2021
Last NPPES UpdateFebruary 25, 20222 updates tracked since enumeration
NPPES CertifiedFebruary 25, 2022
✔ NPI 1437824117 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
130 LAKE AVE, Yonkers, NY 10703
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Other Names 1

Doing Business AsLake Ave Pharmacy

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Anthem Blue Cross and Blue Shield, Avera Health Plans and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lake Ave Pharmacy is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date 2

Next revalidation due by December 31, 2026

This provider holds 2 Medicare enrollments with upcoming revalidation dates. Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateNew YorkEnrollment IDO20210820001645DME · PharmacyDue dateDecember 31, 2026
StateNew YorkEnrollment IDO20220105001229Non-DME Part B · Mass Immunization (Roster Biller Only)Due dateJanuary 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. JOHN LUPO RPH
Pharmacist
130 LAKE AVE
YONKERS, NY 10703
Westchester County (914) 965-3034
LAKE AVE PHARMACY INC
Pharmacy
130 LAKE AVE
YONKERS, NY 10703
Westchester County (914) 965-3034

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Ave Pharma LLC's NPI number?

The NPI number for Lake Ave Pharma LLC is 1437824117. It was assigned to this organization in the NPPES registry on August 13, 2021. The provider is doing business as Lake Ave Pharmacy.

Where is Lake Ave Pharma LLC located?

Lake Ave Pharma LLC is located at 130 Lake Ave, Yonkers, NY 10703. The listed phone number is (914) 965-3034.

What is Lake Ave Pharma LLC's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Is Lake Ave Pharma LLC enrolled in Medicare?

Yes. Lake Ave Pharma LLC is registered in the Medicare PECOS enrollment system.

When is Lake Ave Pharma LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), Lake Ave Pharma LLC holds 2 Medicare enrollments with upcoming revalidation dates. The next is due by December 31, 2026 (DME, New York, Pharmacy). Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

What insurance does Lake Ave Pharma LLC accept?

Health plans from Alliant Health Plans, Inc., Anthem Blue Cross and Blue Shield, Avera Health Plans, Blue Cross Blue Shield of North Dakota and Blue Cross Blue Shield of Wyoming and 23 other insurers list Lake Ave Pharma LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lake Ave Pharma LLC was last updated on February 25, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.