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General NPI Number Information
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NPI Number | 1003596040
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Entity Type | Organization
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Legal Business Name | ISLAND PARK PHARMACY CORP.
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 114 LONG BEACH RD
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City | ISLAND PARK
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State | NY
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Zip | 11558-1439
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Country | US
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Telephone | 516-208-6698
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Fax | 516-208-6697
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Provider Business Mailing Address
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Address Line | 114 LONG BEACH RD
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City | ISLAND PARK
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State | NY
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Zip | 11558-1439
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Country | US
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Telephone | 516-208-6698
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Fax | 516-208-6697
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Authorized Official
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Title or Position | OWNER
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Name | DARLENE RUZICKA
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Credential |
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Telephone | 516-208-6698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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