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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 Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Mail Order Pharmacy

3336M0002X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
 

Specialty Pharmacy

3336S0011X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for SUSITNA PROFESSIONAL PHARMACY

NPI # 1467441808
LBN Legal business name SUSITNA PROFESSIONAL PHARMACY
Authorized official MARY MUNDELL - (EXECUTIVE VP)
Entity Organization
Organization subpart 1 No
Enumeration date 10/18/2005
Last updated 07/26/2012 - About 14 years ago
Identifiers
AK License # 408
AK Medicaid PH0266
Other 0202553 NCPDP PROVIDER IDENTIFICATION NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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