Healthcare Provider Details

I. General information

NPI: 1073066064
Provider Name (Legal Business Name): BKO HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 LAKE ST STE 101
HOMER AK
99603-7692
US

IV. Provider business mailing address

4014 LAKE ST STE 101
HOMER AK
99603-7692
US

V. Phone/Fax

Practice location:
  • Phone: 907-226-2580
  • Fax: 907-226-2620
Mailing address:
  • Phone: 907-226-2580
  • Fax: 907-226-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number113764
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NATHAN SCOTT
Title or Position: OWNER, PIC, AO
Credential: PHARMD
Phone: 907-226-2580