MEDICARE: LEEWARD ISLANDS APOTHECARIES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	210040042006	VI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1264	OTHER	VI	MAP #
2	5300405	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1205987203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEEWARD ISLANDS APOTHECARIES LLC

Provider Business Mailing Address
First Line	:	PO BOX 158
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00821-0158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 SUNNY ISLE SHOPPING CENTER
Second Line	:	SUITE #41
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4493
Country	:	US
Telephone Number	:	340-719-6010
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	TROY DECHABERT SCHUSTER
Credential	:
Telephone Number	:	340-642-3141

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	03/07/2023

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Directions to “LEEWARD ISLANDS APOTHECARIES LLC ” Practice Location

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