Provider Demographics
NPI:1154590362
Name:RAMBRICH, RAY
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:
Last Name:RAMBRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2311
Mailing Address - Country:US
Mailing Address - Phone:212-722-9156
Mailing Address - Fax:212-722-9115
Practice Address - Street 1:160 E 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1722
Practice Address - Country:US
Practice Address - Phone:212-722-9156
Practice Address - Fax:212-722-9115
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044223OtherPHARMACY LICENSE