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General NPI Number Information
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NPI Number | 1063481752
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Entity Type | Organization
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Legal Business Name | ISLAND PHARMACY
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 311 CHISUM ST
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City | SICILY ISLAND
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State | LA
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Zip | 71368-4807
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Country | US
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Telephone | 318-389-5807
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Fax | 318-389-5842
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Provider Business Mailing Address
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Address Line | 311 CHISUM ST
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City | SICILY ISLAND
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State | LA
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Zip | 71368-4807
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Country | US
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Telephone | 318-389-5807
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Fax | 318-389-5842
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Authorized Official
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Title or Position | OWNER
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Name | A G BIRD
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Credential | PHARMACIST
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Telephone | 318-389-5807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 507-IR
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License Number State | LA
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