Provider Demographics
NPI:1497934830
Name:NANTUCKET ISLAND DRUG CORP
Entity Type:Organization
Organization Name:NANTUCKET ISLAND DRUG CORP
Other - Org Name:ISLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-228-6400
Mailing Address - Street 1:122 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-4003
Mailing Address - Country:US
Mailing Address - Phone:508-228-6400
Mailing Address - Fax:508-228-1375
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:508-228-6400
Practice Address - Fax:508-228-1375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NANTUCKET ISLAND DRUG CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4629820001Medicare NSC