Local City Search for Medical Equipment Suppliers SUSITNA PROFESSIONAL PHARMACY
Mail Order Pharmacy
Wasilla, Alaska
Provider NPI: 1467441808
Organization Information:Organization Name: SUSITNA PROFESSIONAL PHARMACY
Practice Location:
1751 E GARDNER WAY STE G WASILLA, AK 99654 US
Tel: 907-373-7933 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
1751 E GARDNER WAY STE G WASILLA, AK 99654 US
Tel: 907-373-7933 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 3336M0002X | Suppliers Pharmacy Mail Order Pharmacy | ||
| N | 3336S0011X | Suppliers Pharmacy | ||
| N | 333600000X | Suppliers Pharmacy | ||
| Y | 3336C0003X | Suppliers Pharmacy | AK | 408 |
Other Provider Identifiers:
| Issuer | Number | State | Type |
|---|---|---|---|
| PH0266 | AK | 05 | |
| NCPDP PROVIDER IDENTIFICATION NUMBER | 0202553 | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
