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General NPI Number Information
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NPI Number | 1104506989
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Entity Type | Organization
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Legal Business Name | ROOTS PHARMACY INC
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 5 NEW HYDE PARK RD
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-3609
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Country | US
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Telephone | 516-302-8430
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Fax | 516-302-8431
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Provider Business Mailing Address
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Address Line | 5 NEW HYDE PARK RD
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-3609
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Country | US
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Telephone | 516-302-8430
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Fax | 516-302-8431
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SARA ILYAS
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Credential |
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Telephone | 516-302-8430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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