Provider Demographics
NPI:1851376834
Name:ROSA PHARMACY, INC.
Entity Type:Organization
Organization Name:ROSA PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:ADOLFO
Authorized Official - Last Name:ARIAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:347-992-6771
Mailing Address - Street 1:1603 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3303
Mailing Address - Country:US
Mailing Address - Phone:212-923-2412
Mailing Address - Fax:212-923-0410
Practice Address - Street 1:1603 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3303
Practice Address - Country:US
Practice Address - Phone:212-923-2412
Practice Address - Fax:212-923-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0250873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3339947OtherNCPDP
NY02173417Medicaid
NY02173417Medicaid