Healthcare Provider Details

I. General information

NPI: 1104749522
Provider Name (Legal Business Name): LONG ISLAND PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163A BROADWAY
HEWLETT NY
11557-2321
US

IV. Provider business mailing address

1163A BROADWAY
HEWLETT NY
11557-2321
US

V. Phone/Fax

Practice location:
  • Phone: 516-218-2654
  • Fax: 516-218-2655
Mailing address:
  • Phone: 516-218-2654
  • Fax: 516-218-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELONA DAVIDOVA
Title or Position: OWNER
Credential:
Phone: 516-218-2654