Organization
ISLA HOME INFUSION INC.
Active
Other names
ISLA HOME INFUSION INC
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN GLICK RPH (PRESIDENT)
(808) 245-1864
Entity
Organization
Contact information
Practice address
202 FARENHOLT AVE STE 101, TAMUNING, GU 96913-3218
(671) 646-1266
(671) 646-1471
Mailing address
202 FARENHOLT AVE STE 101, TAMUNING, GU 96913-3218
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY036
GU
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5428936
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/21/2005
Last updated
10/20/2020
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