Healthcare Provider Details

I. General information

NPI: 1518213685
Provider Name (Legal Business Name): DEREK M WEBER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 19TH AVE
FAIRBANKS AK
99701-5903
US

IV. Provider business mailing address

1408 19TH AVE
FAIRBANKS AK
99701-5903
US

V. Phone/Fax

Practice location:
  • Phone: 907-459-3807
  • Fax:
Mailing address:
  • Phone: 907-459-3807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1985
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: