Provider Demographics
NPI:1861861239
Name:ISLAND CARE PHARMACY INC
Entity Type:Organization
Organization Name:ISLAND CARE PHARMACY INC
Other - Org Name:PARAMOUNT SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSSANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-822-6300
Mailing Address - Street 1:150 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3423
Mailing Address - Country:US
Mailing Address - Phone:518-512-5802
Mailing Address - Fax:518-776-4453
Practice Address - Street 1:150 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3423
Practice Address - Country:US
Practice Address - Phone:518-512-5802
Practice Address - Fax:518-776-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0348143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162368OtherPK