Healthcare Provider Details

I. General information

NPI: 1316598873
Provider Name (Legal Business Name): ISLAND PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S US HWY 64/264
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:
Mailing address:
  • Phone: 252-473-5801
  • Fax: 252-473-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN PHILLIPS
Title or Position: RPH/PRESIDENT
Credential:
Phone: 252-473-5801