Healthcare Provider Details

I. General information

NPI: 1790781912
Provider Name (Legal Business Name): BERNIE'S PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAKE OTIS PARKWAY, SUITE 200
ANCHORAGE AK
99508
US

IV. Provider business mailing address

4100 LAKE OTIS PARKWAY, SUITE 200
ANCHORAGE AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-2138
  • Fax: 907-561-0752
Mailing address:
  • Phone: 907-562-2138
  • Fax: 907-561-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number370
License Number StateAK

VIII. Authorized Official

Name: MRS. TERESA E HALL
Title or Position: CEO
Credential:
Phone: 907-562-2138