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General NPI Number Information
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NPI Number | 1417183518
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Entity Type | Organization
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Legal Business Name | SOUTHSHORE PHARMACY CORP.
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 4020 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10308-3331
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Country | US
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Telephone | 718-948-4848
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Fax | 718-948-4899
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Provider Business Mailing Address
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Address Line | 4020 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10308-3331
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Country | US
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Telephone | 718-948-4848
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Fax | 718-948-4899
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Authorized Official
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Title or Position | PIC/OWNER
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Name | DR. MARIYA N BRAGINSKY
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Credential | RPH
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Telephone | 718-948-4848
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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 | 029457
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License Number State | NY
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