Healthcare Provider Details

I. General information

NPI: 1134254568
Provider Name (Legal Business Name): ANDRE GERARD NEPTUNE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 PROVIDENCE DR PROVIDENCE ALASKA MEDICAL CENTER-INPATIENT PHARMACY
ANCHORAGE AK
99508-4615
US

IV. Provider business mailing address

205 E DIMOND BLVD # 132
ANCHORAGE AK
99515-1909
US

V. Phone/Fax

Practice location:
  • Phone: 907-261-2546
  • Fax: 907-261-3645
Mailing address:
  • Phone: 907-346-8271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number820
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: