Healthcare Provider Details

I. General information

NPI: 1669968442
Provider Name (Legal Business Name): GLENN POWERS MD PHARMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 HOSPITAL DR
JUNEAU AK
99801
US

IV. Provider business mailing address

708 SW 199TH PL
NORMANDY PARK WA
98166-4151
US

V. Phone/Fax

Practice location:
  • Phone: 907-796-8412
  • Fax:
Mailing address:
  • Phone: 206-369-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number127388
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. GLENN IRVING POWERS
Title or Position: OWNER
Credential: MD,PHARMD
Phone: 206-369-4855