Provider Demographics
NPI:1053476820
Name:CHELSEA DRUG STORE LTD REDHOOK
Entity type:Organization
Organization Name:CHELSEA DRUG STORE LTD REDHOOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:R
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:340-776-8300
Mailing Address - Street 1:6500 RED HOOK PLZ STE 102
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-1306
Mailing Address - Country:US
Mailing Address - Phone:340-776-8300
Mailing Address - Fax:340-776-8301
Practice Address - Street 1:6500 RED HOOK PLZ STE 102
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-1306
Practice Address - Country:US
Practice Address - Phone:340-776-8300
Practice Address - Fax:340-776-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1-2022303-20063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI5300316OtherNCPDP NUMBER
VIBC9433866OtherDEA NUMBER
VI6000830001Medicare NSC