Healthcare Provider Details

I. General information

NPI: 1932426467
Provider Name (Legal Business Name): LEEWARD SUNNY ISLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53-B ESTATETWO BROTHERS
FREDERICKSTED VI
00840
US

IV. Provider business mailing address

4500 SUNNY ISLE SUITE #41
CHRISTIANSTED VI
00820-4493
US

V. Phone/Fax

Practice location:
  • Phone: 340-719-6010
  • Fax: 340-719-6008
Mailing address:
  • Phone: 340-719-6010
  • Fax: 340-719-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberC1000125212009
License Number StateVI

VIII. Authorized Official

Name: MR. TROY ANTHONY SCHUSTER
Title or Position: MANAGING MEMBER
Credential:
Phone: 340-719-6010