Provider Demographics
NPI:1740058403
Name:RAMBHAROSE, ALEX ANTHONY (RPH)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:ANTHONY
Last Name:RAMBHAROSE
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 1:9009 215TH PL
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1229
Mailing Address - Country:US
Mailing Address - Phone:347-845-1008
Mailing Address - Fax:
Practice Address - Street 1:1829 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2453
Practice Address - Country:US
Practice Address - Phone:516-378-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist