Healthcare Provider Details

I. General information

NPI: 1962415646
Provider Name (Legal Business Name): ISLAND INFUSION PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ARZUAGA 108 ALTOS
SAN JUAN PR
00925
US

IV. Provider business mailing address

PO BOX 21333
SAN JUAN PR
00928-1333
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-6959
  • Fax: 787-764-3771
Mailing address:
  • Phone: 787-756-6959
  • Fax: 787-764-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number18F2386
License Number StatePR

VIII. Authorized Official

Name: EMILY RUIZ
Title or Position: PRESIDENT
Credential:
Phone: 787-756-6959