MEDICARE: ISLAND CHEMISTS 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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336S0011X	Specialty Pharmacy
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	028819	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3303966	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861482101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND CHEMISTS INC

Provider Business Mailing Address
First Line	:	353 NEWBRIDGE RD
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-4120
Country	:	US
Telephone Number	:	516-785-0120
Fax Number	:	516-785-0715

Provider Business Practice Location Address
First Line	:	353 NEWBRIDGE RD
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-4120
Country	:	US
Telephone Number	:	516-785-0120
Fax Number	:	516-785-0715

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RANDOLPH MOHABIR
Credential	:
Telephone Number	:	516-785-0120

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	12/20/2011

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Directions to “ISLAND CHEMISTS INC ” Practice Location

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