Provider Demographics
NPI:1003596040
Name:ISLAND PARK PHARMACY CORP.
Entity Type:Organization
Organization Name:ISLAND PARK PHARMACY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUZICKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-208-6698
Mailing Address - Street 1:114 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1439
Mailing Address - Country:US
Mailing Address - Phone:516-208-6698
Mailing Address - Fax:516-208-6697
Practice Address - Street 1:114 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1439
Practice Address - Country:US
Practice Address - Phone:516-208-6698
Practice Address - Fax:516-208-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy