Provider Demographics
NPI:1326820978
Name:ST. RAPHAEL PHARMACY INC
Entity Type:Organization
Organization Name:ST. RAPHAEL PHARMACY INC
Other - Org Name:ST RAPHAEL PHARMACY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-424-4538
Mailing Address - Street 1:35-04C JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-5362
Mailing Address - Country:US
Mailing Address - Phone:718-424-4538
Mailing Address - Fax:718-424-4537
Practice Address - Street 1:35-04C JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-5362
Practice Address - Country:US
Practice Address - Phone:718-424-4538
Practice Address - Fax:718-424-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy