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NPI Code Detail

MEDICARE: HILLSIDE PHARMACY INC

MEDICARE: HILLSIDE PHARMACY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy030828NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15803209OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1588944326
Entity Type Code : Organization
Provider Name (Legal Business Name) : HILLSIDE PHARMACY INC
Provider Business Mailing Address
First Line : 22036 HILLSIDE AVE
Second Line :
City : QUEENS VILLAGE
State : NY
Zip : 11427-2020
Country : US
Telephone Number : 718-264-2222
Fax Number : 718-264-2221
Provider Business Practice Location Address
First Line : 22036 HILLSIDE AVE
Second Line :
City : QUEENS VILLAGE
State : NY
Zip : 11427-2020
Country : US
Telephone Number : 718-264-2222
Fax Number : 718-264-2221
Authorized Official
Title or Position : PHARMACIST
Name : ISSAAC GEORGE
Credential :
Telephone Number : 718-264-2222
Provider Enumeration Date : 08/25/2011
Last Update Date : 05/22/2012

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Directions to “HILLSIDE PHARMACY INC ” Practice Location

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