1336260710 NPI number — INTER ISLAND PHARMACIES INC

Table of content: JOHN JERIUS MD (NPI 1306848353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336260710 NPI number — INTER ISLAND PHARMACIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTER ISLAND PHARMACIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DOCTORS CHOICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336260710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11536
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST THOMAS
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00801-4536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEDICAL ARTS COMPLEX
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-774-8988
Provider Business Practice Location Address Fax Number:
340-774-8986
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENJAMIN
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MGR
Authorized Official Telephone Number:
340-775-0484

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 120284152007 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5300227 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5300227 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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