Healthcare Provider Details

I. General information

NPI: 1225439433
Provider Name (Legal Business Name): ELISE M BANKOWSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2014
Last Update Date: 09/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W DIMOND BLVD
ANCHORAGE AK
99515-1469
US

IV. Provider business mailing address

2000 W DIMOND BLVD
ANCHORAGE AK
99515-1469
US

V. Phone/Fax

Practice location:
  • Phone: 907-267-6733
  • Fax:
Mailing address:
  • Phone: 907-267-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2264
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: