Provider Demographics
NPI:1447345764
Name:FAR ROCKAWAY PHARMACY CORP
Entity type:Organization
Organization Name:FAR ROCKAWAY PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAVINKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-327-2511
Mailing Address - Street 1:2119 MOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-3215
Mailing Address - Country:US
Mailing Address - Phone:718-327-2511
Mailing Address - Fax:718-327-5887
Practice Address - Street 1:2119 MOTT AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3215
Practice Address - Country:US
Practice Address - Phone:718-327-2511
Practice Address - Fax:718-327-5887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0188953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00927266Medicaid
NY018895OtherSTATE PHARMACY NUMBER
NY018895OtherSTATE PHARMACY NUMBER
4953470001Medicare NSC