Healthcare Provider Details

I. General information

NPI: 1306952247
Provider Name (Legal Business Name): FOUNDATION HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COWLES ST DEPT 41 C
FAIRBANKS AK
99701-5907
US

IV. Provider business mailing address

1650 COWLES ST
FAIRBANKS AK
99701-5907
US

V. Phone/Fax

Practice location:
  • Phone: 907-458-5615
  • Fax: 907-458-5060
Mailing address:
  • Phone: 907-458-5550
  • Fax: 907-458-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY G SUDDUTH
Title or Position: CFO
Credential:
Phone: 907-458-5300