Old Town Pharmacy, Inc
NPI 1063574739 · Community/Retail Pharmacy · Staten Island, NY
Enrolled with Medicare as Part B Supplier - Pharmacy · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Old Town Pharmacy, Inc is a Community/Retail Pharmacy organization in Staten Island, NY (NPI 1063574739).
Provider details
- NPI number
- 1063574739
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Inna Ichtchenko, Prsident(718) 815-2600
Specialties & taxonomies
Suppliers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2006-12-15
- Last updated
- 2021-08-31
- Certified
- 2021-08-31
Frequently asked questions
- What is Old Town Pharmacy, Inc's NPI number?
- Old Town Pharmacy, Inc's National Provider Identifier (NPI) is 1063574739, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Old Town Pharmacy, Inc?
- Old Town Pharmacy, Inc is classified in the NPPES registry as Community/Retail Pharmacy (Suppliers).
- Where is Old Town Pharmacy, Inc located?
- Old Town Pharmacy, Inc's practice location on file with NPPES is 1250 Hylan Blvd Ste 3a, Staten Island, NY 10305-1944.
- What is Old Town Pharmacy, Inc's phone number?
- The practice phone number listed in the NPPES registry for Old Town Pharmacy, Inc is (718) 815-2600.
- Does Old Town Pharmacy, Inc accept Medicare?
- Old Town Pharmacy, Inc is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Old Town Pharmacy, Inc?
- The authorized official listed on Old Town Pharmacy, Inc's NPPES record is Inna Ichtchenko, Prsident. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Old Town Pharmacy, Inc's NPI active?
- Yes — Old Town Pharmacy, Inc's NPI (1063574739) is active in the NPPES registry as of the last update on 2021-08-31.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.