Provider Demographics
NPI:1831104439
Name:RAINDEW COVERT LTD
Entity Type:Organization
Organization Name:RAINDEW COVERT LTD
Other - Org Name:RAINDEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:
Authorized Official - Last Name:SFORZA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-354-1227
Mailing Address - Street 1:73 COVERT AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3218
Mailing Address - Country:US
Mailing Address - Phone:516-354-1227
Mailing Address - Fax:516-354-0974
Practice Address - Street 1:73 COVERT AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3218
Practice Address - Country:US
Practice Address - Phone:516-354-1227
Practice Address - Fax:516-354-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0242573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01906261Medicaid
2064452OtherPK
2064452OtherPK