Healthcare Provider Details

I. General information

NPI: 1598686180
Provider Name (Legal Business Name): OCEAN BREEZE RX INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 HYLAN BLVD
STATEN ISLAND NY
10305-1918
US

IV. Provider business mailing address

1817 HYLAN BLVD
STATEN ISLAND NY
10305-1918
US

V. Phone/Fax

Practice location:
  • Phone: 718-987-2525
  • Fax: 718-987-4316
Mailing address:
  • Phone: 718-987-2525
  • Fax: 718-987-4316

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: NOUREEN RAIFQ
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 718-987-2525