Provider Demographics
NPI:1750463725
Name:RALPH PLACE PHARMACY INC
Entity Type:Organization
Organization Name:RALPH PLACE PHARMACY INC
Other - Org Name:RALPH PLACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BLATT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-720-9640
Mailing Address - Street 1:11 RALPH PL
Mailing Address - Street 2:SUITE 106
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4419
Mailing Address - Country:US
Mailing Address - Phone:718-720-9640
Mailing Address - Fax:718-720-9649
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:SUITE 106
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4419
Practice Address - Country:US
Practice Address - Phone:718-720-9640
Practice Address - Fax:718-720-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01378087Medicaid
3330610OtherNCPDP