Healthcare Provider Details

I. General information

NPI: 1386687622
Provider Name (Legal Business Name): TRADEWINDS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARAGON MEDICAL BUILDING SUITE 101
ST THOMAS VI
00802
US

IV. Provider business mailing address

PARAGON MEDICAL BUILDING SUITE 101
ST THOMAS VI
00802
US

V. Phone/Fax

Practice location:
  • Phone: 340-775-2625
  • Fax: 340-775-2610
Mailing address:
  • Phone: 340-775-2625
  • Fax: 340-775-2610

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 Number206225
License Number StateVI

VIII. Authorized Official

Name: RICHARD ASHMORE
Title or Position: PRESIDENT
Credential:
Phone: 340-776-0103