Provider Demographics
NPI:1205914272
Name:ROCKAWAY RX INC
Entity type:Organization
Organization Name:ROCKAWAY RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHULAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SABIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-498-3941
Mailing Address - Street 1:9238 SILVER ROAD
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2442
Mailing Address - Country:US
Mailing Address - Phone:646-387-5638
Mailing Address - Fax:
Practice Address - Street 1:710 ROCKAWAY AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5456
Practice Address - Country:US
Practice Address - Phone:718-498-3941
Practice Address - Fax:718-922-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0272453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02621507Medicaid
NY02621507Medicaid