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General NPI Number Information
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NPI Number | 1225143266
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Entity Type | Organization
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Legal Business Name | ISLAND PHARMACY INC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 210 S HWY 64
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City | MANTEO
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State | NC
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Zip | 27954
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Country | US
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Telephone | 252-473-5801
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Fax | 252-473-2130
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Provider Business Mailing Address
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Address Line | PO BOX 2027
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City | MANTEO
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State | NC
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Zip | 27954-2027
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Country | US
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Telephone | 252-473-5801
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Fax | 252-473-2130
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN PHILLIPS
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Credential | RPH
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Telephone | 252-473-5801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 09435
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License Number State | NC
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