Provider Demographics
NPI:1124073978
Name:FAR ROCKAWAY DRUGS INC
Entity type:Organization
Organization Name:FAR ROCKAWAY DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHCY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-471-2500
Mailing Address - Street 1:17 27 SEAGIRT BLVD
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-471-2500
Mailing Address - Fax:718-471-0840
Practice Address - Street 1:17 27 SEAGIRT BLVD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-471-2500
Practice Address - Fax:718-471-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X, 333600000X
NY0273663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33D2204084OtherLIMITED SERVICES LABORATORY REGISTRATION
NY2664611Medicaid
2064281OtherPK