Provider Demographics
NPI:1316414766
Name:NANTUCKET ISLAND PHARMACY LLC
Entity Type:Organization
Organization Name:NANTUCKET ISLAND PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:TRINKS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-228-6400
Mailing Address - Street 1:41 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1426
Mailing Address - Country:US
Mailing Address - Phone:508-553-9662
Mailing Address - Fax:608-553-9662
Practice Address - Street 1:122 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4003
Practice Address - Country:US
Practice Address - Phone:617-924-1595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy