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Organization
ISLAND DRUG, LLC
Active
Organization
ISLAND DRUG, LLC
Active
Other names
ISLAND DRUG INC
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL TILLIS (OWNER)
(228) 217-5192
Entity
Organization
Contact information
Practice address
3645 GULF SHORES PARKWAY, STE 107, GULF SHORES, AL 36542-2721
(251) 967-1100
(251) 967-1200
Mailing address
P.O. BOX 4147, GULF SHORES, AL 36547
(251) 967-1100
(251) 967-1200
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
113101
AL
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881861383
—
AL
01
—
1996299
PK
—
Enumeration date
05/14/2008
Last updated
05/30/2024
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