Healthcare Provider Details

I. General information

NPI: 1194812024
Provider Name (Legal Business Name): SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/13/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300A KLAWOCK HOLLIS HIGHWAY
KLAWOCK AK
99925
US

IV. Provider business mailing address

3100 CHANNEL DRIVE STE 300
JUNEAU AK
99801
US

V. Phone/Fax

Practice location:
  • Phone: 907-523-4343
  • Fax: 907-600-5121
Mailing address:
  • Phone: 907-463-4074
  • Fax: 907-463-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number113762
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number113762
License Number StateAK

VIII. Authorized Official

Name: DANIEL HARRIS
Title or Position: SE VP / CFO
Credential:
Phone: 907-463-4000