Provider Demographics
NPI:1114265493
Name:RML PHARMACY, P.C.
Entity Type:Organization
Organization Name:RML PHARMACY, P.C.
Other - Org Name:BROOKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVARNWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-627-3060
Mailing Address - Street 1:4481 LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2404
Mailing Address - Country:US
Mailing Address - Phone:716-627-3060
Mailing Address - Fax:716-627-3129
Practice Address - Street 1:4481 LAKE SHORE RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2404
Practice Address - Country:US
Practice Address - Phone:716-627-3060
Practice Address - Fax:716-627-3129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03725968Medicaid
J300103265OtherMEDICARE IMMUNIZATIONS
6769920001Medicare NSC