Healthcare Provider Details

I. General information

NPI: 1659765360
Provider Name (Legal Business Name): KRISTINE PERCIVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 DEBARR RD
ANCHORAGE AK
99508-2948
US

IV. Provider business mailing address

535 E PALMER WASILLA HWY
PALMER AK
99645-6575
US

V. Phone/Fax

Practice location:
  • Phone: 907-564-3547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2283
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: