Healthcare Provider Details

I. General information

NPI: 1740412394
Provider Name (Legal Business Name): DON YAMASHITA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703-0000
US

IV. Provider business mailing address

4076 NEELY ROAD
FORT WAINWIGHT AK
99703-0000
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-5765
  • Fax: 907-361-4838
Mailing address:
  • Phone: 907-361-5765
  • Fax: 907-361-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033-0003509
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3251
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number3509
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: