MEDICARE: ROCKAWAY BEACH PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1851160691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKAWAY BEACH PHARMACY INC

Provider Business Mailing Address
First Line	:	7505 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6637
Country	:	US
Telephone Number	:	347-207-8919
Fax Number	:	718-233-8788

Provider Business Practice Location Address
First Line	:	10119 ROCKAWAY BEACH BLVD
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2841
Country	:	US
Telephone Number	:	718-233-8787
Fax Number	:	718-233-8788

Authorized Official
Title or Position	:	OWNER
Name	:	MR. IGOR ABRAMOV
Credential	:	PHARMD
Telephone Number	:	347-207-8919

Provider Enumeration Date	:	12/21/2023
Last Update Date	:	12/21/2023

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