Provider Demographics
NPI:1881861383
Name:ISLAND DRUG INC
Entity Type:Organization
Organization Name:ISLAND DRUG INC
Other - Org Name:ISLAND DRUG INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-967-1100
Mailing Address - Street 1:PO BOX 4048
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36547-4048
Mailing Address - Country:US
Mailing Address - Phone:251-967-1100
Mailing Address - Fax:251-967-1200
Practice Address - Street 1:3645 GULF SHORES PKWY
Practice Address - Street 2:STE 107
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-2721
Practice Address - Country:US
Practice Address - Phone:251-967-1100
Practice Address - Fax:251-967-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
AL1131013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1996299OtherPK
AL1881861383Medicaid