Provider Demographics
NPI:1962586016
Name:RAINDEW PHARMACY LTD
Entity type:Organization
Organization Name:RAINDEW PHARMACY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:VERNI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-539-7752
Mailing Address - Street 1:35-15 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11577
Mailing Address - Country:US
Mailing Address - Phone:718-539-7752
Mailing Address - Fax:718-445-8250
Practice Address - Street 1:35-15 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11577
Practice Address - Country:US
Practice Address - Phone:718-539-7752
Practice Address - Fax:718-445-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0186693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00900638Medicaid
NY3383368OtherNABP NUMBER
NY4727840001Medicare ID - Type Unspecified