904 Prospect Pharmacy Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

904 PROSPECT PHARMACY INC

Doing business as

Boca Pharmacy

Practice address

904 Prospect Ave
Bronx, NY 10459-3929

Phone

(718) 991-6700

Fax

(718) 874-1378

NPI assigned

Oct 7, 2006

Last updated

Jul 30, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacob JamronNPI 1841309614

Title

Ceo

Phone

(718) 991-6700

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• BOCA PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in NY3 enrollments

Enrollment records 3

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacob Jamron

  • Pharmacist
  • Bronx, NY
  • NPI 1841309614
  NPD (past) Authorized official
• Jong Dae Lee

  • Pharmacist
  • Bronx, NY
  • NPI 1043468218
  NPD (past)
• Kathleen MC Laughlin, PHARMD

  • Pharmacist
  • Bronx, NY
  • NPI 1790039006
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753833600000",
    "number": "1043307242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 740054",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104740001",
            "telephone_number": "718-991-6700",
            "fax_number": "718-874-1378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 PROSPECT AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104593929",
            "telephone_number": "718-991-6700",
            "fax_number": "718-874-1378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "904 PROSPECT PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-07",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A",
        "authorized_official_last_name": "JAMRON",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-991-6700"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "027296",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2064042",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2664726",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BOCA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BOCA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Bronx, NY
• Providers in Bronx, NY by specialty
• Long Term Care Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.