Provider Demographics
NPI:1689744070
Name:ISLAND PHARMACY INC
Entity Type:Organization
Organization Name:ISLAND PHARMACY INC
Other - Org Name:ISLAND PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMBORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-336-2800
Mailing Address - Street 1:1841 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6512
Mailing Address - Country:US
Mailing Address - Phone:718-336-2800
Mailing Address - Fax:718-998-1105
Practice Address - Street 1:1841 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6512
Practice Address - Country:US
Practice Address - Phone:718-336-2800
Practice Address - Fax:718-998-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0232123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01729551Medicaid
3319351OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3319351OtherNCPDP PROVIDER IDENTIFICATION NUMBER