Provider Demographics
NPI:1457348005
Name:ROCKAWAY DRUGS INC.
Entity Type:Organization
Organization Name:ROCKAWAY DRUGS INC.
Other - Org Name:KINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:RABINOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-318-0300
Mailing Address - Street 1:194 BEACH 116TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2417
Mailing Address - Country:US
Mailing Address - Phone:718-318-0300
Mailing Address - Fax:718-318-3378
Practice Address - Street 1:194 BEACH 116TH ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2417
Practice Address - Country:US
Practice Address - Phone:718-318-0300
Practice Address - Fax:718-318-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025058333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02144021Medicaid
NY4202180001Medicare ID - Type UnspecifiedMEDICARE ID