Healthcare Provider Details

I. General information

NPI: 1073658431
Provider Name (Legal Business Name): ANCHORAGE NATIVE PRIMARY CARE CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 DIPLOMACY DR
ANCHORAGE AK
99508-5925
US

IV. Provider business mailing address

4320 DIPLOMACY DR
ANCHORAGE AK
99508-5925
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-4172
  • Fax: 907-729-2154
Mailing address:
  • Phone: 907-729-2159
  • Fax: 907-729-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CALLISTA CARLTON
Title or Position: CLINICAL DIRECTOR OF PHARMACY
Credential: PHARM.D.
Phone: 907-729-5111