<Unavail>
LBN: Susitna Professional Pharmacy
<Unavail> is an health care organization with primary practice located at 1751 E Gardner Way Ste G, Wasilla AK 99654-6564. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Mail Order Pharmacy, Suppliers / Specialty Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Susitna Professional Pharmacy can be contacted via phone (907) 373-7933, or through Mundell, Mary via phone (907) 373-7933.
Contact Information
Primary practice address
1751 E Gardner Way Ste G
Wasilla AK 99654-6564
Phone: (907) 373-7933
Fax: (907) 373-7939
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 408 | Alaska |
| Suppliers / Mail Order Pharmacy | 3336M0002X | ||
| Suppliers / Specialty Pharmacy | 3336S0011X |
Profile Details
| NPI number | 1467441808 |
|---|---|
| LBN Legal business name | Susitna Professional Pharmacy |
| DBA Doing business as | <Unavail> |
| Authorized official | Mundell, Mary |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 18th, 2005 |
| Last updated | Jul 26th, 2012 - about 14 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1467441808 | NPPES |
| Alaska | MEDICAID | PH0266 | |
| Alaska | Other | 0202553 |
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