Provider Demographics
NPI:1417962044
Name:ISLA DRUG STORES INC
Entity Type:Organization
Organization Name:ISLA DRUG STORES INC
Other - Org Name:ISLA DRUG STORES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-427-7123
Mailing Address - Street 1:1994 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3644
Mailing Address - Country:US
Mailing Address - Phone:212-427-7123
Mailing Address - Fax:212-828-9359
Practice Address - Street 1:1994 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3644
Practice Address - Country:US
Practice Address - Phone:212-427-7123
Practice Address - Fax:212-828-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0132513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00564172Medicaid
2067749OtherPK
NY4297080001Medicare NSC