Provider Demographics
NPI:1467469643
Name:ISLAND INFUSION PHARMACY
Entity Type:Organization
Organization Name:ISLAND INFUSION PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-767-2626
Mailing Address - Street 1:ST ARZUAGA #108 ESQ. MONSENOR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928
Mailing Address - Country:US
Mailing Address - Phone:787-767-2626
Mailing Address - Fax:
Practice Address - Street 1:108 CALLE ARZUAGA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3718
Practice Address - Country:US
Practice Address - Phone:787-767-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization