Individual provider Active NPI

Robert F. Petsche, RPH.

  • Pharmacist
  • Ozone Park, NY
National Provider Identifier
1295904746
Registry record updated Feb 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
044636 Issued in NY
Practice address
9210 Atlantic Ave
Ozone Park, NY 11416-1517
Phone
(718) 835-7903
NPI assigned
Feb 28, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 044636 NY Primary

Addresses

Primary practice location

9210 Atlantic Ave
Ozone Park, NY 11416-1517

Mailing address

6918 62ND Dr
Middle Village, NY 11379-1102
Phone (718) 326-2804

Other identifiers 1

IdentifierTypeStateIssuer
044636OtherNYPHARMACY LICENSCE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
044636NYMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204156800000",
    "number": "1295904746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6918 62ND DR",
            "city": "MIDDLE VILLAGE",
            "state": "NY",
            "postal_code": "113791102",
            "telephone_number": "718-326-2804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9210 ATLANTIC AVE",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114161517",
            "telephone_number": "718-835-7903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETSCHE",
        "first_name": "ROBERT",
        "middle_name": "F.",
        "name_prefix": "Mr.",
        "credential": "RPH.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-28",
        "last_updated": "2008-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "044636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSCE #",
            "identifier": "044636",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ozone Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.