Provider Demographics
NPI:1104970425
Name:CHELSEA DRUG STORE
Entity type:Organization
Organization Name:CHELSEA DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-776-4888
Mailing Address - Street 1:5205 EST ENIGHED
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:VI
Mailing Address - Zip Code:00830
Mailing Address - Country:US
Mailing Address - Phone:340-776-4888
Mailing Address - Fax:340-776-4887
Practice Address - Street 1:5205 EST ENIGHED
Practice Address - Street 2:
Practice Address - City:ST JOHN
Practice Address - State:VI
Practice Address - Zip Code:00830
Practice Address - Country:US
Practice Address - Phone:340-776-4888
Practice Address - Fax:340-776-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI32026075333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
6090330001Medicare NSC