Healthcare Provider Details

I. General information

NPI: 1285458075
Provider Name (Legal Business Name): MICHAEL PAUL DISTANTE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 DEBARR RD STE A
ANCHORAGE AK
99504-1869
US

IV. Provider business mailing address

215 GLENN ABBEY PL
ANCHORAGE AK
99504-4892
US

V. Phone/Fax

Practice location:
  • Phone: 907-269-1733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number228690
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: