Provider Demographics
NPI:1518988583
Name:ROCKWAYRX INC.
Entity Type:Organization
Organization Name:ROCKWAYRX INC.
Other - Org Name:ROCKWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-462-6527
Mailing Address - Street 1:1214 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7047
Mailing Address - Country:US
Mailing Address - Phone:718-462-6527
Mailing Address - Fax:718-462-6479
Practice Address - Street 1:1214 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7047
Practice Address - Country:US
Practice Address - Phone:718-462-6527
Practice Address - Fax:718-462-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0207263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01913253Medicaid
2067217OtherPK