MEDICARE: LONG BEACH PHARMA CORP

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
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1861382301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH PHARMA CORP

Provider Business Mailing Address
First Line	:	3251 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-3649
Country	:	US
Telephone Number	:	516-600-9261
Fax Number	:

Provider Business Practice Location Address
First Line	:	3251 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-3649
Country	:	US
Telephone Number	:	516-600-9261
Fax Number	:	516-604-3139

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELI IAKOUBOV
Credential	:
Telephone Number	:	516-600-9261

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	07/17/2025

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Directions to “LONG BEACH PHARMA CORP ” Practice Location

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