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NPI Code Detail

MEDICARE: LONG ISLAND PHARMACY CORP

MEDICARE: LONG ISLAND PHARMACY CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336L0003XLong Term Care Pharmacy
23336S0011XSpecialty Pharmacy
33336H0001XHome Infusion Therapy Pharmacy

General Provider Information

NPI Number : 1184468837
Entity Type Code : Organization
Provider Name (Legal Business Name) : LONG ISLAND PHARMACY CORP
Provider Business Mailing Address
First Line : 1163A BROADWAY
Second Line :
City : HEWLETT
State : NY
Zip : 11557-2321
Country : US
Telephone Number : 516-218-2654
Fax Number : 516-218-2655
Provider Business Practice Location Address
First Line : 1163A BROADWAY
Second Line :
City : HEWLETT
State : NY
Zip : 11557-2321
Country : US
Telephone Number : 516-218-2654
Fax Number : 516-218-2655
Authorized Official
Title or Position : OWNER
Name : ELONA DAVIDOVA
Credential :
Telephone Number : 516-218-2654
Provider Enumeration Date : 06/19/2024
Last Update Date : 12/04/2024

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