Old Town Pharmacy, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

OLD TOWN PHARMACY, INC

Practice address

1250 Hylan Blvd Ste 3a
Staten Island, NY 10305-1944

Phone

(718) 815-2600

Fax

(718) 815-2095

NPI assigned

Dec 15, 2006

Last updated

Aug 31, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Inna IchtchenkoNPI 1083938047

Title

Prsident

Phone

(718) 815-2600

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Inna Ichtchenko, BS IN PHARMACY

  • Pharmacist
  • Staten Island, NY
  • NPI 1083938047
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1063574739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103051943",
            "telephone_number": "718-815-2600",
            "fax_number": "718-815-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 HYLAN BLVD STE 3A",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103051944",
            "telephone_number": "718-815-2600",
            "fax_number": "718-815-2095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A",
        "authorized_official_last_name": "ICHTCHENKO",
        "authorized_official_first_name": "INNA",
        "authorized_official_title_or_position": "PRSIDENT",
        "authorized_official_telephone_number": "718-815-2600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02664717",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olanike Olaniyi
• Oluwatoyin Olatunji, LPN
• Temitope Olatunji, LPN
• Jazlyn Marie Olavarria, MS
• Comfort Odunayo Olayemi, LPN
• Christopher Ryan Oldaker, MD
• Jorge Ariel Oldan, M.D.
• Oleg Dron Handz on Occupational Therapy PC
• Olga Kheyson MD PC
• Mukumaoy Olimjonova

• Community/Retail Pharmacy in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.