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General NPI Number Information
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NPI Number | 1881776664
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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 | 10/20/2006
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 3526 TONGASS AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5635
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Country | US
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Telephone | 907-225-6186
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Fax | 907-225-6187
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Provider Business Mailing Address
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Address Line | 3526 TONGASS AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5635
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Country | US
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Telephone | 907-225-6186
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Fax | 907-226-6187
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE CHRISTENSEN
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Credential |
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Telephone | 907-225-6186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail 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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 66
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License Number State | AK
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