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General NPI Number Information
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NPI Number | 1487772661
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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 | 03/27/2007
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 2330 PALM RIDGE RD STE 12
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City | SANIBEL
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State | FL
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Zip | 33957-3280
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Country | US
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Telephone | 239-472-6188
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Fax | 239-472-6144
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Provider Business Mailing Address
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Address Line | 2330 PALM RIDGE RD STE 12
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City | SANIBEL
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State | FL
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Zip | 33957-3280
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Country | US
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Telephone | 239-472-6188
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Fax | 239-472-6144
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAJIMON MATHAI
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Credential | RPH
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Telephone | 239-245-1654
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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 | PH22606
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License Number State | FL
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