Organization
ROSE DRUG STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OSAHON EVANS IMAFIDON (PRESIDENT)
(718) 812-9654
Entity
Organization
Contact information
Practice address
262 E BURNSIDE AVE, BRONX, NY 10457-3724
(171) 829-1470
Mailing address
262 E BURNSIDE AVE, BRONX, NY 10457-3724
(171) 829-1470
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
029002
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029002
BOARD OF PHARMACY
NY
05
—
03044066
—
NY
01
—
3358531
NCPDP
NY
Enumeration date
08/03/2008
Last updated
03/07/2023
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