Provider Demographics
NPI:1992194385
Name:AMDAN INCORPORATED
Entity Type:Organization
Organization Name:AMDAN INCORPORATED
Other - Org Name:THE MEDICINE SHOPPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-776-1235
Mailing Address - Street 1:PO BOX 600180
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-6180
Mailing Address - Country:US
Mailing Address - Phone:340-776-1235
Mailing Address - Fax:340-776-1776
Practice Address - Street 1:9004 HAVENSIGHT SHOPP CTR
Practice Address - Street 2:SUITE D THROUGH F
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2657
Practice Address - Country:US
Practice Address - Phone:340-776-1235
Practice Address - Fax:340-776-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1-30441-1L333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150784OtherPK