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General NPI Number Information
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NPI Number | 1689894909
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Entity Type | Organization
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Legal Business Name | GRAND ISLAND PHARMACY, INC.
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 1728 GRAND ISLAND BLVD
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City | GRAND ISLAND
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State | NY
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Zip | 14072
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Country | US
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Telephone | 716-773-5665
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Fax | 716-773-5665
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Provider Business Mailing Address
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Address Line | 1022 BURROUGH RD
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City | COWLESVILLE
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State | NY
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Zip | 14037-9752
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Country | US
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Telephone | 716-553-6515
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Fax | 716-773-5665
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Authorized Official
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Title or Position | PRESIDENT
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Name | RYAN M LAVARNWAY
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Credential |
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Telephone | 716-553-6515
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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 | 028339
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License Number State | NY
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