Provider Demographics
NPI:1316196579
Name:HABOUR ISLAND PHARMACY LLC
Entity Type:Organization
Organization Name:HABOUR ISLAND PHARMACY LLC
Other - Org Name:HABOUR ISLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SWITLYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-784-0333
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 S HARBOUR ISLAND BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5735
Practice Address - Country:US
Practice Address - Phone:813-374-0206
Practice Address - Fax:813-374-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH234423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1037729OtherNCPDP PROVIDER IDENTIFICATION NUMBER