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General NPI Number Information
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NPI Number | 1790952208
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Entity Type | Organization
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Legal Business Name | ISLANDIA PHARMACY LTD
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 333 S BROADWAY
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City | HICKSVILLE
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State | NY
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Zip | 11801-5005
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Country | US
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Telephone | 516-939-9800
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Fax | 516-939-9801
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Provider Business Mailing Address
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Address Line | 333 S BROADWAY
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City | HICKSVILLE
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State | NY
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Zip | 11801-5005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOMTAZ HASAN
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Credential |
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Telephone | 516-647-1582
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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 | 028913
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License Number State | NY
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