Provider Demographics
NPI:1629091392
Name:R & A PHARMACY INC.
Entity Type:Organization
Organization Name:R & A PHARMACY INC.
Other - Org Name:PARK PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRABODH
Authorized Official - Middle Name:D
Authorized Official - Last Name:AJBANI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-583-5900
Mailing Address - Street 1:1773 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:718-583-5900
Mailing Address - Fax:
Practice Address - Street 1:1773 UNIVERSITY AVE
Practice Address - Street 2:(AKA 1773 DR MARTIN LUTHER KING BLVED)
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:718-583-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0234683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01871392Medicaid
NY3311026OtherNCPDP #