Basic Information
| Provider Information | |||||||||
| NPI: | 1396938049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHIFF | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2088 | ||||||||
| Address2: | 201 THIRD AVE, STE 201 | ||||||||
| City: | SEWARD | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996642088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072243490 | ||||||||
| FaxNumber: | 9072245870 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 THIRD AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SEWARD | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996642088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072243490 | ||||||||
| FaxNumber: | 9072245870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2007 | ||||||||
| LastUpdateDate: | 08/24/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 1613 | AK | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | CL3490 | 05 | AK | MEDICAID |