MEDICARE: ROSEDALE PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	032408	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2144012	OTHER		PK

General Provider Information

NPI Number	:	1275955056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEDALE PHARMACY LLC

Provider Business Mailing Address
First Line	:	3671 BRONXWOOD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-1147
Country	:	US
Telephone Number	:	718-684-2318
Fax Number	:	718-684-2320

Provider Business Practice Location Address
First Line	:	1737 E 174TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-1801
Country	:	US
Telephone Number	:	718-684-2318
Fax Number	:	718-684-2320

Authorized Official
Title or Position	:	MEMBER
Name	:	CHAIM GLICK
Credential	:
Telephone Number	:	718-684-2318

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	12/02/2025

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Directions to “ROSEDALE PHARMACY LLC ” Practice Location

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