Old Town Pharmacy, Inc

LBN: Old Town Pharmacy, Inc
Old Town Pharmacy, Inc is an health care organization with primary practice located at 1250 Hylan Blvd Ste 3A , Staten Island NY 10305-1944. The organization recently has only one registered license in Suppliers / Community/Retail Pharmacy, which is considered as the primary health care specialty. Old Town Pharmacy, Inc can be contacted via phone (718) 815-2600, or through Ichtchenko, Inna via phone (718) 815-2600.

Contact Information

Primary practice address
1250 Hylan Blvd Ste 3A Staten Island NY 10305-1944
Phone: (718) 815-2600
Fax: (718) 815-2095
Website:
Map and Directions
Authorized official contact:
Name: Ichtchenko, Inna
Phone: (718) 815-2600

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X

Profile Details

NPI number 1063574739
LBN Legal business name Old Town Pharmacy, Inc
DBA Doing business as
Authorized official Ichtchenko, Inna
Entity Organization
Organization subpart 1 No
Enumeration date Dec 15th, 2006
Last updated Aug 31st, 2021 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063574739 NPPES
New York MEDICAID 02664717

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