Provider Demographics
NPI:1770657298
Name:RMH RETAIL PHARMACY LLC
Entity Type:Organization
Organization Name:RMH RETAIL PHARMACY LLC
Other - Org Name:RMH RETAIL PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGNANO
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:315-338-7690
Mailing Address - Street 1:1500 N JAMES ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2844
Mailing Address - Country:US
Mailing Address - Phone:315-338-7690
Mailing Address - Fax:315-338-7697
Practice Address - Street 1:1500 N JAMES ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2844
Practice Address - Country:US
Practice Address - Phone:315-338-7690
Practice Address - Fax:315-338-7697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
NY0249153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02143084Medicaid
2063040OtherPK
4162390001Medicare NSC