Provider Demographics
NPI:1316598873
Name:ISLAND PHARMACY INC
Entity Type:Organization
Organization Name:ISLAND PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-473-5801
Mailing Address - Street 1:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-2027
Mailing Address - Country:US
Mailing Address - Phone:252-473-5801
Mailing Address - Fax:252-473-2130
Practice Address - Street 1:210 S US HWY 64/264
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954
Practice Address - Country:US
Practice Address - Phone:252-473-5801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0285294Medicaid