Provider Demographics
NPI:1811707227
Name:ISLAND FAMILY PHARMACY INC
Entity type:Organization
Organization Name:ISLAND FAMILY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-461-1081
Mailing Address - Street 1:600 PLANTATION ISLAND DR S STE 3
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6010
Mailing Address - Country:US
Mailing Address - Phone:904-461-1081
Mailing Address - Fax:904-461-1082
Practice Address - Street 1:600 PLANTATION ISLAND DR S STE 3
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6010
Practice Address - Country:US
Practice Address - Phone:904-461-1081
Practice Address - Fax:904-461-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy