Organization
ISLAND DRUG AND WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BANNISTER (MANAGER)
(318) 927-3523
Entity
Organization
Contact information
Practice address
311 CHISUM ST, SICILY ISLAND, LA 71368-4807
(318) 389-5807
(318) 389-1090
Mailing address
PO BOX 729, BENTON, LA 71006-0729
(318) 389-5807
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2207385
—
LA
01
—
PHY.008184-IR
PHARMACY PERMIT
LA
Enumeration date
12/07/2020
Last updated
03/23/2021
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