=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093943185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R.M.R. PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2009
-----------------------------------------------------
Last Update Date | 03/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6508 ROOSEVELT AVE WOODSIDE
-----------------------------------------------------
City | WOODSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11377-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-448-6965
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6508 ROOSEVELT AVE WOODSIDE
-----------------------------------------------------
City | WOODSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11377-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-448-6965
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RAFAEL AUGUSTO RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-448-6965
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 029516
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------