Healthcare Provider Details

I. General information

NPI: 1851390496
Provider Name (Legal Business Name): ISLAND CITY APOTHECARY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 WEBB ST
CUMBERLAND WI
54829-9187
US

IV. Provider business mailing address

1470 WEBB ST
CUMBERLAND WI
54829-9187
US

V. Phone/Fax

Practice location:
  • Phone: 715-822-2424
  • Fax: 715-822-5470
Mailing address:
  • Phone: 715-822-2424
  • Fax: 715-822-5470

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 Number9490-42
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: THOMAS GOLDSMITH
Title or Position: OWNER
Credential: RPH
Phone: 715-822-2424