90-15 Roosevelt Pharmacy Corp
Organization Active NPI Community/Retail Pharmacy · Jackson Heights, NY
NPI 1831201847 · NPPES record last updated Sep 19, 2025
Key facts
- NPI
- 1831201847
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 024229 (NY)
- Legal business name
- 90-15 ROOSEVELT PHARMACY CORP
- Practice address
- 9015 Roosevelt Ave
Jackson Heights, NY 11372-7938 - Phone
- (718) 429-7666
- Fax
- (718) 898-9505
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Elena Luna, RPH
- Title
- President
- Phone
- (718) 429-7666
Practitioners 4
-
Elena Luna, RPH
-
Carmen L Crespo, RPH
-
Winnie Hang Diep, PHARMD
-
Cindy Ivette Luna, PHARM D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930008598 | NY | DME Supplier - Pharmacy | 7315142676 | Practice locations: Jackson Heights, NY |
| O20220107001964 | NY | Part B Supplier - Mass Immunization (Roster Biller Only) | 7315142676 | Practice locations: Jackson Heights, NY |
National Provider Directory
Locations
9015 Roosevelt Ave
Jackson Heights, NY 11372
Phone (718) 429-7666
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 024229 | NY | Yes |
Addresses
Primary practice location
9015 Roosevelt Ave
Jackson Heights, NY 11372-7938
Mailing address
9015 Roosevelt Ave
Jackson Heights, NY 11372-7938
Phone (718) 429-7666
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922307 | Medicaid | NY | |
| 2057679 | Other | PK |
Other names
- MI FARMACIA
Other providers in Jackson Heights, NY
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- 77 Pharmacy Inc
- 77 Pharmacy Inc
- 82ND Dental PLLC
- 84 Street Medical PC
- 9301 Health Medical Corner PC
- 9317 Medical Office PC
- A1 Medicine P.C.
- Richard Allen Aaron
- Wendell Jamias Abad
All providers in Jackson Heights, NY · Community/Retail Pharmacy in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.