Healthcare Provider Details

I. General information

NPI: 1225143266
Provider Name (Legal Business Name): ISLAND PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S HWY 64
MANTEO NC
27954
US

IV. Provider business mailing address

PO BOX 2027
MANTEO NC
27954-2027
US

V. Phone/Fax

Practice location:
  • Phone: 252-473-5801
  • Fax: 252-473-2130
Mailing address:
  • Phone: 252-473-5801
  • Fax: 252-473-2130

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 Number09435
License Number StateNC

VIII. Authorized Official

Name: KEVIN PHILLIPS
Title or Position: OWNER
Credential: RPH
Phone: 252-473-5801