Provider Demographics
NPI:1013014943
Name:JEROME & MILTON ROSENBLUM INC
Entity Type:Organization
Organization Name:JEROME & MILTON ROSENBLUM INC
Other - Org Name:ROSS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROBBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-693-4138
Mailing Address - Street 1:4908 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3406
Mailing Address - Country:US
Mailing Address - Phone:718-693-4138
Mailing Address - Fax:718-940-1691
Practice Address - Street 1:4908 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3406
Practice Address - Country:US
Practice Address - Phone:718-693-4138
Practice Address - Fax:718-940-1691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0122133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2058842OtherPK
NY01203910Medicaid
3307091OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY6063790001Medicare NSC