Organization
GRAND ISLAND PHARMACY, INC.
Active
Other names
Island Prescription Center
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN M LAVARNWAY (PRESIDENT)
(716) 553-6515
Entity
Organization
Contact information
Practice address
1728 GRAND ISLAND BLVD, GRAND ISLAND, NY 14072
(716) 773-5665
(716) 773-5665
Mailing address
1022 BURROUGH RD, COWLESVILLE, NY 14037-9752
(716) 553-6515
(716) 773-5665
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
028339
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028339
STATE REGISTRATION NUMBER
NY
05
—
02916329
—
NY
01
—
3353911
NCPDP NUMBER
—
Enumeration date
04/27/2007
Last updated
08/11/2022
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