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General NPI Number Information
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NPI Number | 1255296299
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Entity Type | Organization
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Legal Business Name | 77 PHARMACY INC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 8215 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7034
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Country | US
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Telephone | 718-898-7777
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Fax | 718-898-7775
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Provider Business Mailing Address
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Address Line | 8215 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7034
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Country | US
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Telephone | 718-898-7777
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Fax | 718-898-7775
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Authorized Official
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Title or Position | OWNER
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Name | RONALD RIVAS
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Credential |
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Telephone | 718-684-1595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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