Provider Demographics
NPI:1457652042
Name:VIRGIN ISLANDS IV
Entity Type:Organization
Organization Name:VIRGIN ISLANDS IV
Other - Org Name:VIRGIN ISLANDS IV, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-513-4703
Mailing Address - Street 1:2024 EST. MT. WELCOME
Mailing Address - Street 2:SUITE #12
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:340-719-8448
Mailing Address - Fax:340-719-8484
Practice Address - Street 1:2024 EST. MT. WELCOME
Practice Address - Street 2:SUITE #12
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-719-8448
Practice Address - Fax:340-719-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
VI50095183336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5300493OtherNCPDP PROVIDER IDENTIFICATION NUMBER