Staten Island Pharmacy Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

STATEN ISLAND PHARMACY INC.

Practice address

1807 Victory Blvd
Staten Island, NY 10314-3515

Phone

(718) 448-5200

Fax

(718) 448-5311

NPI assigned

Dec 23, 2012

Organization subpart

No

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

Authorized official

Name

Nicky Legakis, PHARMD.

Title

Supervising Pharmacist

Phone

(718) 448-5200

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

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

{
    "created_epoch": "1356220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643587200000",
    "number": "1982940763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143515",
            "telephone_number": "718-448-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143515",
            "telephone_number": "718-448-5200",
            "fax_number": "718-448-5311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-23",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "LEGAKIS",
        "authorized_official_first_name": "NICKY",
        "authorized_official_title_or_position": "SUPERVISING PHARMACIST",
        "authorized_official_telephone_number": "718-448-5200",
        "authorized_official_credential": "PHARMD."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03548143",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Staten Island Pain & Rehabilitation, P.C.
• Staten Island Pediatric Cardiology, PLLC
• Staten Island Pediatric Dentistry
• Staten Island Pediatric Hematology Oncology Assoc.
• Staten Island Performing Provider System LLC
• Staten Island Physcial Therapy PC
• Staten Island Physical Therapy & Rehab, PC
• Staten Island Physician Practice PC
• Staten Island Podiatry Obs,PLLC
• Staten Island Podiatry, P.C.

• 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 Jan 31, 2022; 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.