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General NPI Number Information
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NPI Number | 1235625468
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Entity Type | Organization
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Legal Business Name | ISLAND PHARMACY & DISCOUNT CORP
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 290 CITY ISLAND AVE
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City | BRONX
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State | NY
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Zip | 10464
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Country | US
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Telephone | 718-885-1000
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Fax | 718-885-1001
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Provider Business Mailing Address
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Address Line | 290 CITY ISLAND AVE
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City | BRONX
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State | NY
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Zip | 10464-1433
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Country | US
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Telephone | 718-885-1000
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Fax | 718-885-1001
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAFAELINA TATIS
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Credential |
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Telephone | 718-885-1000
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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 | 036657
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License Number State | NY
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