Provider Demographics
NPI:1972749018
Name:FORDHAM ROAD PHARMACY INC.
Entity Type:Organization
Organization Name:FORDHAM ROAD PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-840-1616
Mailing Address - Street 1:2 E FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5445
Mailing Address - Country:US
Mailing Address - Phone:718-364-3333
Mailing Address - Fax:718-364-3334
Practice Address - Street 1:2 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5445
Practice Address - Country:US
Practice Address - Phone:718-364-3333
Practice Address - Fax:718-364-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029249251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6194040001Medicare NSC
NY4747Medicare PIN