Provider Demographics
NPI:1275955056
Name:ROSEDALE PHARMACY LLC
Entity Type:Organization
Organization Name:ROSEDALE PHARMACY LLC
Other - Org Name:ROSEDALE PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-684-2318
Mailing Address - Street 1:3671 BRONXWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1147
Mailing Address - Country:US
Mailing Address - Phone:718-684-2318
Mailing Address - Fax:718-684-2320
Practice Address - Street 1:1737 E 174TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-1801
Practice Address - Country:US
Practice Address - Phone:718-684-2318
Practice Address - Fax:718-684-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0324083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144012OtherPK