904 PROSPECT PHARMACY INC NPI 1043307242

NPI Information

  • NPI: 1043307242
  • Provider Name: 904 PROSPECT PHARMACY INC
  • Classification: Pharmacy - 3336L0003X
  • Specialization: Long Term Care Pharmacy
  • Entity Type: Organization
  • :
  • Address: 904 PROSPECT AVE
    BRONX, NY
    ZIP 10459
  • Phone: (718) 991-6700

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NPI Details

904 PROSPECT PHARMACY INC is a long term care pharmacy pharmacy in Bronx, NY. The provider is a pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. 904 PROSPECT PHARMACY INC NPI is 1043307242. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

904 PROSPECT AVE
BRONX, NY
ZIP 10459-929
Phone: (718) 991-6700
Fax: (718) 874-1378

The provider's authorized official is Jacob Jamron .
The authorized official title is Ceo and has the following contact phone number (718) 991-6700.

The enumeration date for this NPI number is 10/7/2006 and was last updated on 7/30/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
13336C0003XPharmacyCommunity/Retail Pharmacy027296NEW YORKNo
23336S0011XPharmacySpecialty PharmacyNo
33336L0003XPharmacyLong Term Care PharmacyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12664726MEDICAIDNEW YORK
22064042OTHERPK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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