Provider Demographics
NPI:1700109212
Name:ROSSI, JOHN PETER (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PETER
Last Name:ROSSI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 MARGINAL RD
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-5229
Mailing Address - Country:US
Mailing Address - Phone:718-845-6840
Mailing Address - Fax:718-845-9247
Practice Address - Street 1:8401 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2017
Practice Address - Country:US
Practice Address - Phone:718-845-6840
Practice Address - Fax:718-845-9247
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00340661Medicaid