# SOUTHSHORE PHARMACY CORP.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417183518
- **Authorized official:** DR. MARIYA N BRAGINSKY RPH (PIC/OWNER)
- **Authorized official phone:** (718) 948-4848

## Contact information

- **Practice address:** 4020 HYLAN BLVD, STATEN ISLAND, NY 10308-3331
- **Practice address phone:** (718) 948-4848
- **Practice address fax:** (718) 948-4899
- **Mailing address:** 4020 HYLAN BLVD, STATEN ISLAND, NY 10308-3331
- **Mailing address phone:** (718) 948-4848
- **Mailing address fax:** (718) 948-4899

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 029457 | NY | Yes |

## Other

- **Enumeration date:** 06/03/2009
- **Last updated:** 07/27/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 03132134 | — | NY |