Healthcare Provider Details

I. General information

NPI: 1346361722
Provider Name (Legal Business Name): INTER ISLAND PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4C AND 4D ESTATE SION FARM
ST CROIX VI
00820
US

IV. Provider business mailing address

PO BOX 11536
ST THOMAS VI
00801-4536
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-2266
  • Fax: 340-778-3191
Mailing address:
  • Phone:
  • Fax:

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 Number220284312007
License Number StateVI

VIII. Authorized Official

Name: JINNA BENJAMIN
Title or Position: OFFICE MGR
Credential:
Phone: 340-775-0484