=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417009218
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | N.O.B.PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1336 PENINSULA BLVD
-----------------------------------------------------
City | HEWLETT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11557-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-791-6700
-----------------------------------------------------
Fax | 516-791-8324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1336 PENINSULA BLVD
-----------------------------------------------------
City | HEWLETT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11557-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-791-6700
-----------------------------------------------------
Fax | 516-791-8324
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. ROBERT ROCHFORD
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 516-791-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 031945
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------