Healthcare Provider Details

I. General information

NPI: 1003596040
Provider Name (Legal Business Name): ISLAND PARK PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 LONG BEACH RD
ISLAND PARK NY
11558-1439
US

IV. Provider business mailing address

114 LONG BEACH RD
ISLAND PARK NY
11558-1439
US

V. Phone/Fax

Practice location:
  • Phone: 516-208-6698
  • Fax: 516-208-6697
Mailing address:
  • Phone: 516-208-6698
  • Fax: 516-208-6697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ILHOM ISMAILOV
Title or Position: OWNER
Credential:
Phone: 516-208-6698