Provider Demographics
NPI:1154544872
Name:ROSSMORE PHARMACY
Entity type:Organization
Organization Name:ROSSMORE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:COZZARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-759-1956
Mailing Address - Street 1:338 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3249
Mailing Address - Country:US
Mailing Address - Phone:973-759-1956
Mailing Address - Fax:973-759-2027
Practice Address - Street 1:338 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3249
Practice Address - Country:US
Practice Address - Phone:973-759-1956
Practice Address - Fax:973-759-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00209000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4256701Medicaid
NJ0198110001Medicare ID - Type UnspecifiedMEDICARE