Healthcare Provider Details

I. General information

NPI: 1033297205
Provider Name (Legal Business Name): LUKE ST JOHN CULLINS PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KANAKANAK ROAD MEDICAL STAFF OFFICE
DILLINGHAM AK
99576
US

IV. Provider business mailing address

PO BOX 1111
DILLINGHAM AK
99576
US

V. Phone/Fax

Practice location:
  • Phone: 907-842-9218
  • Fax: 907-842-9250
Mailing address:
  • Phone: 907-842-9235
  • Fax: 907-842-9240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1489
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: