National Provider Identifier Database

SUSITNA PROFESSIONAL PHARMACY
Community/Retail Pharmacy

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.


Contact Information

SUSITNA PROFESSIONAL PHARMACY
1751 E GARDNER WAY
STE G
WASILLA, AK99654-6564
Phone: 907-373-7933
Fax: 907-373-7939
Website:
Specialty Taxonomy Code
* Community/Retail Pharmacy 3336C0003X
Mail Order Pharmacy 3336M0002X
Pharmacy 333600000X
Specialty Pharmacy 3336S0011X

* Indicates primary specialty

NPI Profile & details for SUSITNA PROFESSIONAL PHARMACY

NPI Number 1467441808
Legal business name
LBN
SUSITNA PROFESSIONAL PHARMACY
Authorized official MARY MUNDELL - (EXECUTIVE VP)
Entity Organization
Organization subpart No
Enumeration date 10/18/2005
Last updated 07/26/2012 - About 14 years ago
Sole proprietor1 Not specified
Identifiers
  • AK License #: 408
  • AK Medicaid: PH0266
  • Other: 0202553 NCPDP PROVIDER IDENTIFICATION NUMBER

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for SUSITNA PROFESSIONAL PHARMACY

There are currently no reviews for SUSITNA PROFESSIONAL PHARMACY


NPIdb - Home
v2.201