Provider Demographics
NPI:1184789745
Name:RCK PHARMACY LLC
Entity type:Organization
Organization Name:RCK PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AO
Authorized Official - Prefix:
Authorized Official - First Name:RAMABHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-467-2605
Mailing Address - Street 1:520 W 207TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2646
Mailing Address - Country:US
Mailing Address - Phone:212-567-1350
Mailing Address - Fax:212-567-1350
Practice Address - Street 1:520 W 207TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2646
Practice Address - Country:US
Practice Address - Phone:212-567-1350
Practice Address - Fax:212-567-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2019-05-20
Deactivation Date:2019-05-15
Deactivation Code:
Reactivation Date:2019-05-20
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0243053336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175474OtherPK
NY1295910001Medicaid