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SUSITNA PROFESSIONAL PHARMACY NPI 1467441808


NPI Information

NPI: 1467441808
Provider Name: SUSITNA PROFESSIONAL PHARMACY

Doing Business As: SUSITNA PROFESSIONAL PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
1751 E GARDNER WAY
STE G
WASILLA, AK
ZIP 99654
Phone: (907) 373-7933
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SUSITNA PROFESSIONAL PHARMACY is a community/retail pharmacy pharmacy in Wasilla, AK. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. SUSITNA PROFESSIONAL PHARMACY NPI is 1467441808. The provider is registered as an organization entity type.
The provider Is Doing Business As Susitna Professional Pharmacy.

The provider's business location address is:

1751 E GARDNER WAY
STE G
WASILLA, AK
ZIP 99654-564
Phone: (907) 373-7933
Fax: (907) 373-7939

The provider's authorized official is Mary Mundell .
The authorized official title is Executive Vp and has the following contact phone number (907) 373-7933.

The enumeration date for this NPI number is 10/18/2005 and was last updated on 7/26/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13336M0002XPharmacyMail Order PharmacyNo
23336S0011XPharmacySpecialty PharmacyNo
3333600000XPharmacyNo
43336C0003XPharmacyCommunity/Retail Pharmacy408ALASKAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10202553OTHERNCPDP PROVIDER IDENTIFICATION NUMBER
2PH0266MEDICAIDALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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