MEDICARE: SOUTHCENTRAL FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1841138856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHCENTRAL FOUNDATION

Provider Business Mailing Address
First Line	:	4320 DIPLOMACY DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508
Country	:	US
Telephone Number	:	907-729-5111
Fax Number	:	907-729-8700

Provider Business Practice Location Address
First Line	:	4330 ELMORE ROAD, SUITE 3300
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508
Country	:	US
Telephone Number	:	907-729-4172
Fax Number	:	907-729-8870

Authorized Official
Title or Position	:	ADMINISTRATOR OF REVENUE OPERATIONS
Name	:	MICHELLE ALLISON WENGER
Credential	:
Telephone Number	:	907-729-4286

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “SOUTHCENTRAL FOUNDATION ” Practice Location

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