Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Old Town Pharmacy, Inc

Organization Community/Retail Pharmacy · NPI 1063574739

Old Town Pharmacy, Inc is a Community/Retail Pharmacy in Staten Island, New York. Registered with an NPI since 2006.

In the registry since
2006
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1250 Hylan Blvd Ste 3A
Staten Island, NY 10305-1944
Phone: (718) 815-2600
Fax: (718) 815-2095
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community/Retail Pharmacy (primary) Taxonomy 3336C0003X

Record details

NPI number1063574739
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Inna Ichtchenko — Prsident · (718) 815-2600
NPI enumeratedDecember 15, 2006
Last updated in NPPESAugust 31, 2021
Certification dateAugust 31, 2021
Mailing address1250 Hylan Blvd, Staten Island, NY 10305-1943

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