Provider Demographics
NPI:1124062807
Name:ISLAND PHARMACY
Entity type:Organization
Organization Name:ISLAND PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-786-7878
Mailing Address - Street 1:303 1ST AVE
Mailing Address - Street 2:P O BOX 2506
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-8752
Mailing Address - Country:US
Mailing Address - Phone:912-786-7878
Mailing Address - Fax:912-786-7774
Practice Address - Street 1:303 1ST STREET
Practice Address - Street 2:#2506
Practice Address - City:TYBEE ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31328
Practice Address - Country:US
Practice Address - Phone:912-786-7878
Practice Address - Fax:912-786-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0087573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy