Healthcare Provider Details

I. General information

NPI: 1427300185
Provider Name (Legal Business Name): JAMES A. WYCOFF RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 GLACIER HWY
JUNEAU AK
99801-7905
US

IV. Provider business mailing address

PO BOX 33715
JUNEAU AK
99803-3715
US

V. Phone/Fax

Practice location:
  • Phone: 907-789-2440
  • Fax:
Mailing address:
  • Phone: 907-586-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number825
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: