Basic Information
| Provider Information | |||||||||
| NPI: | 1194812024 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEARHC - ALICIA ROBERTS MEDICAL CENTER PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 CHANNEL DRIVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074634074 | ||||||||
| FaxNumber: | 9074631510 | ||||||||
| Practice Location | |||||||||
| Address1: | 13004 KLAWOCK HOLLIS HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | KLAWOCK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077554800 | ||||||||
| FaxNumber: | 9077554806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 05/31/2017 | ||||||||
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| AuthorizedOfficialLastName: | NEUMEISTER | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9074634000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 113762 | AK | N | Suppliers | Pharmacy | 332800000X | 113762 | AK | Y | Suppliers | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | CL2276 | 05 | AK | MEDICAID | PH0025 | 05 | AK | MEDICAID | 0202604 | 01 | AK | NCPDP | OTHER |