Healthcare Provider Details

I. General information

NPI: 1801617824
Provider Name (Legal Business Name): CARRIE URENA PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE DUPLISEA

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 KLAWOCK HOLLIS HWY
KLAWOCK AK
99925
US

IV. Provider business mailing address

PO BOX 690
KLAWOCK AK
99925-0690
US

V. Phone/Fax

Practice location:
  • Phone: 907-523-4313
  • Fax:
Mailing address:
  • Phone: 907-888-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number196376
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: