Healthcare Provider Details

I. General information

NPI: 1487772661
Provider Name (Legal Business Name): ISLAND PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 PALM RIDGE RD STE 12
SANIBEL FL
33957-3280
US

IV. Provider business mailing address

2330 PALM RIDGE RD STE 12
SANIBEL FL
33957-3280
US

V. Phone/Fax

Practice location:
  • Phone: 239-472-6188
  • Fax: 239-472-6144
Mailing address:
  • Phone: 239-472-6188
  • Fax: 239-472-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22606
License Number StateFL

VIII. Authorized Official

Name: RAJIMON MATHAI
Title or Position: PRESIDENT
Credential: RPH
Phone: 239-245-1654