Organization
904 PROSPECT PHARMACY INC
Active
Other names
BOCA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB JAMRON (CEO)
(718) 991-6700
Entity
Organization
Contact information
Practice address
904 PROSPECT AVE, BRONX, NY 10459-3929
(718) 991-6700
(718) 874-1378
Mailing address
PO BOX 740054, BRONX, NY 10474-0001
(718) 991-6700
(718) 874-1378
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
027296
NY
3336L0003X
Long Term Care Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2064042
PK
—
05
—
2664726
—
NY
Enumeration date
10/07/2006
Last updated
07/30/2025
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