Healthcare Provider Details

I. General information

NPI: 1770578296
Provider Name (Legal Business Name): NORTH POLE PRESCRIPTION LABORATORY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 SANTA CLAUS LANE
NORTH POLE AK
99705
US

IV. Provider business mailing address

167 SANTA CLAUS LANE
NORTH POLE AK
99705
US

V. Phone/Fax

Practice location:
  • Phone: 907-488-8555
  • Fax: 907-488-8556
Mailing address:
  • Phone: 907-488-8555
  • Fax: 907-488-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number128081
License Number StateAK

VIII. Authorized Official

Name: DR. LEIF JOSEPH HOLM
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 907-488-8555