Healthcare Provider Details

I. General information

NPI: 1467534537
Provider Name (Legal Business Name): CROSS ROAD HEALTH MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MILE 187 GLENN HWY
GLENNALLEN AK
99588
US

IV. Provider business mailing address

PO BOX 5
GLENNALLEN AK
99588-0589
US

V. Phone/Fax

Practice location:
  • Phone: 907-822-3336
  • Fax: 907-822-5376
Mailing address:
  • Phone: 907-822-3336
  • Fax: 907-822-5376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number115647
License Number StateAK

VIII. Authorized Official

Name: STEVEN WILLIAM GALLAGHER
Title or Position: CEO
Credential:
Phone: 907-822-5686