Grand Island Pharmacy, Inc.
Organization Active NPI Community/Retail Pharmacy · Grand Island, NY
NPI 1689894909 · NPPES record last updated Aug 11, 2022
Key facts
- NPI
- 1689894909
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 028339 (NY)
- Legal business name
- GRAND ISLAND PHARMACY, INC.
- Practice address
- 1728 Grand Island Blvd
Grand Island, NY 14072 - Phone
- (716) 773-5665
- Fax
- (716) 773-5665
- NPI assigned
- Apr 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Ryan M Lavarnway
- Title
- President
- Phone
- (716) 553-6515
Practitioners 4
-
Peter C. Klopp, PHARMD
-
Allyson Leigh Raditic, PHARMD
-
Ryan Jeffrey Miller, PHARM.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2184418 | Island Prescription Center | Certificate of waiver | Mar 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220906000688 | NY | Part B Supplier - Pharmacy | 6608250956 | Practice locations: Grand Island, NY |
| O20241219003310 | NY | Part B Supplier - Mass Immunization (Roster Biller Only) | 6608250956 | Practice locations: Grand Island, NY |
National Provider Directory
Locations
1728 Grand Island Blvd
Grand Island, NY 14072
Phone (716) 773-5599
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 028339 | NY | Yes |
Addresses
Primary practice location
1728 Grand Island Blvd
Grand Island, NY 14072
Mailing address
1022 Burrough Rd
Cowlesville, NY 14037-9752
Phone (716) 553-6515
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 028339 | Other | NY | STATE REGISTRATION NUMBER |
| 3353911 | Other | NCPDP NUMBER | |
| 02916329 | Medicaid | NY |
Other names
- Island Prescription Center
Other providers in Grand Island, NY
- Tricia Lee Giambelluca
- Grand Island Bodyworks Physical Therapy PLLC
- Grand Island Central School District
- Grand Island Chiropractic PC
- Grand Island Optical Co. Inc.
- Grand Island Physical Therapy PC
- Grand Island Primary Medical Care, LLP
- Melisa Granville
- Marissa Louise Gress
- Lisa Marie Guariglia
All providers in Grand Island, NY · Community/Retail Pharmacy in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.