Provider Demographics
NPI:1164971818
Name:ISLAND DRUGS LLC
Entity Type:Organization
Organization Name:ISLAND DRUGS LLC
Other - Org Name:ISLAND DRUGS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-490-5595
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-0043
Mailing Address - Country:US
Mailing Address - Phone:516-490-5595
Mailing Address - Fax:516-490-5594
Practice Address - Street 1:336 N BROADWAY
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2031
Practice Address - Country:US
Practice Address - Phone:516-490-5595
Practice Address - Fax:516-490-5594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0350083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164444OtherPK
NY7585060001Medicare NSC