Healthcare Provider Details

I. General information

NPI: 1447917224
Provider Name (Legal Business Name): JOHN P ROSENBOOM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 PORT WASHINGTON BLVD
PORT WASHINGTON NY
11050-2910
US

IV. Provider business mailing address

4139 170TH ST
FLUSHING NY
11358-2713
US

V. Phone/Fax

Practice location:
  • Phone: 516-944-6148
  • Fax:
Mailing address:
  • Phone: 718-594-0802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068578
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: