Healthcare Provider Details

I. General information

NPI: 1487572558
Provider Name (Legal Business Name): PETER SOVULA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 LAKE OTIS PKWY
ANCHORAGE AK
99508-5216
US

IV. Provider business mailing address

4353 LAKE OTIS PKWY
ANCHORAGE AK
99508-5216
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-2005
  • Fax:
Mailing address:
  • Phone: 907-561-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number254820
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: