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General NPI Number Information
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NPI Number | 1205181609
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Entity Type | Organization
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Legal Business Name | NEW ISLAND PHARMACY INC
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 1912 DEER PARK AVE
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City | DEER PARK
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State | NY
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Zip | 11729-3332
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Country | US
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Telephone | 631-392-4800
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Fax | 631-392-4801
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Provider Business Mailing Address
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Address Line | 1912 DEER PARK AVE STE A
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City | DEER PARK
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State | NY
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Zip | 11729-3332
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Country | US
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Telephone | 631-392-4800
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Fax | 631-392-4801
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | NIDHIN MOHAN
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Credential |
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Telephone | 631-392-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 031408
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License Number State | NY
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