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General NPI Number Information
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NPI Number | 1669913992
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Entity Type | Organization
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Legal Business Name | ROOSEVELT CITY PHARMACY INC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 7918 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6717
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Country | US
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Telephone | 718-255-1065
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Fax | 718-255-6734
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Provider Business Mailing Address
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Address Line | 7918 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6717
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Country | US
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Telephone | 718-255-1065
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Fax | 718-255-6734
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Authorized Official
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Title or Position | PRESIDENT
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Name | HAIYING LI
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Credential |
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Telephone | 718-255-1065
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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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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 035296
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License Number State | NY
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