Provider Demographics
NPI:1912184987
Name:ROCKAWAY FAMILY PHARMACY CORP
Entity Type:Organization
Organization Name:ROCKAWAY FAMILY PHARMACY CORP
Other - Org Name:BOCA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:YARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-991-3519
Mailing Address - Street 1:PO BOX 740054
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10474-0001
Mailing Address - Country:US
Mailing Address - Phone:718-991-3519
Mailing Address - Fax:
Practice Address - Street 1:872 HUNTS POINT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-5402
Practice Address - Country:US
Practice Address - Phone:718-991-3519
Practice Address - Fax:718-608-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0287523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02950347Medicaid
2070130OtherPK
6070050001Medicare NSC