Provider Demographics
NPI:1851583629
Name:ISLAND PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:ISLAND PHARMACY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:REEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-358-7712
Mailing Address - Street 1:PO BOX 1412
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-1412
Mailing Address - Country:US
Mailing Address - Phone:715-358-7712
Mailing Address - Fax:
Practice Address - Street 1:1256 OLD HIGHWAY 51 SOUTH
Practice Address - Street 2:
Practice Address - City:ARBOR VITAE
Practice Address - State:WI
Practice Address - Zip Code:54568
Practice Address - Country:US
Practice Address - Phone:715-358-7712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7780-042333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy