MEDICARE: HARBOR HILL PHARMACY, LLC

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
1	3336C0003X	Community/Retail Pharmacy	046636	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497976419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR HILL PHARMACY, LLC

Provider Business Mailing Address
First Line	:	310 GLEN COVE RD
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1846
Country	:	US
Telephone Number	:	516-621-1185
Fax Number	:	516-621-1480

Provider Business Practice Location Address
First Line	:	310 GLEN COVE RD
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1846
Country	:	US
Telephone Number	:	516-621-1185
Fax Number	:	516-621-1480

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	IRINA KREYCHMAN
Credential	:	RPH
Telephone Number	:	516-621-1185

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	08/22/2020

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