Provider Demographics
NPI:1912945569
Name:LA RUCHE PHARMACY,INC
Entity Type:Organization
Organization Name:LA RUCHE PHARMACY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-485-6923
Mailing Address - Street 1:494 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3248
Mailing Address - Country:US
Mailing Address - Phone:718-485-6923
Mailing Address - Fax:718-922-3287
Practice Address - Street 1:494 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3248
Practice Address - Country:US
Practice Address - Phone:718-485-6923
Practice Address - Fax:718-922-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0195963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3390755OtherNABP NUMBER
NY01048379Medicaid
NY01048379Medicaid
4688580001Medicare NSC