Healthcare Provider Details

I. General information

NPI: 1902809429
Provider Name (Legal Business Name): JAMES M MORAN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 PROVIDENCE DR
ANCHORAGE AK
99508-4661
US

IV. Provider business mailing address

PO BOX 234177
ANCHORAGE AK
99523-4177
US

V. Phone/Fax

Practice location:
  • Phone: 907-261-3636
  • Fax: 907-261-3645
Mailing address:
  • Phone: 907-344-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1335
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: