Provider Demographics
NPI:1932426467
Name:LEEWARD SUNNY ISLE, LLC
Entity Type:Organization
Organization Name:LEEWARD SUNNY ISLE, LLC
Other - Org Name:THE MEDICINE SHOPPE PHARMACY #1887
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SCHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-719-6010
Mailing Address - Street 1:4500 SUNNY ISLE
Mailing Address - Street 2:SUITE #41
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4493
Mailing Address - Country:US
Mailing Address - Phone:340-719-6010
Mailing Address - Fax:340-719-6008
Practice Address - Street 1:53-B ESTATETWO BROTHERS
Practice Address - Street 2:
Practice Address - City:FREDERICKSTED
Practice Address - State:VI
Practice Address - Zip Code:00840
Practice Address - Country:US
Practice Address - Phone:340-719-6010
Practice Address - Fax:340-719-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VIC1000125212009333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy