Healthcare Provider Details

I. General information

NPI: 1154493666
Provider Name (Legal Business Name): MANIILAQ HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH ST AND GRIZZLEY
KOTZEBUE AK
99752
US

IV. Provider business mailing address

PO BOX 43
KOTZEBUE AK
99752-0043
US

V. Phone/Fax

Practice location:
  • Phone: 907-442-7182
  • Fax: 907-442-7309
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FREDDY KANIKI
Title or Position: PHRM CHIEF
Credential: PHRMD
Phone: 907-442-7336