Provider Demographics
NPI:1497859458
Name:ROSSI PHARMACY
Entity Type:Organization
Organization Name:ROSSI PHARMACY
Other - Org Name:ROSSI PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-845-6840
Mailing Address - Street 1:905 MARGINAL RD
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-5229
Mailing Address - Country:US
Mailing Address - Phone:516-889-5182
Mailing Address - Fax:718-845-9247
Practice Address - Street 1:84 01 101 AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416
Practice Address - Country:US
Practice Address - Phone:718-845-6840
Practice Address - Fax:718-845-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0163303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00340661Medicaid
3366196OtherNCPDP PROVIDER IDENTIFICATION NUMBER