# 904 PROSPECT PHARMACY INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** BOCA PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043307242
- **Authorized official:** JACOB JAMRON (CEO)
- **Authorized official phone:** (718) 991-6700

## Contact information

- **Practice address:** 904 PROSPECT AVE, BRONX, NY 10459-3929
- **Practice address phone:** (718) 991-6700
- **Practice address fax:** (718) 874-1378
- **Mailing address:** PO BOX 740054, BRONX, NY 10474-0001
- **Mailing address phone:** (718) 991-6700
- **Mailing address fax:** (718) 874-1378

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 027296 | NY | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 10/07/2006
- **Last updated:** 07/30/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2064042 | PK | — |
| 05 | — | 2664726 | — | NY |