Healthcare Provider Details

I. General information

NPI: 1346591203
Provider Name (Legal Business Name): DEREK J STOLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E NORTHERN LIGHTS BLVD
ANCHORAGE AK
99508-4283
US

IV. Provider business mailing address

8900 OLD SEWARD HWY
ANCHORAGE AK
99515-2022
US

V. Phone/Fax

Practice location:
  • Phone: 907-264-9633
  • Fax:
Mailing address:
  • Phone: 907-344-7300
  • Fax: 907-344-7305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number1215
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: