Healthcare Provider Details

I. General information

NPI: 1730094319
Provider Name (Legal Business Name): DANE SIDNEY BRUBAKER PHAMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S WOODWORTH LOOP
PALMER AK
99645-8984
US

IV. Provider business mailing address

2500 S WOODWORTH LOOP
PALMER AK
99645-8984
US

V. Phone/Fax

Practice location:
  • Phone: 907-861-6699
  • Fax: 907-861-6731
Mailing address:
  • Phone: 907-861-6699
  • Fax: 907-861-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHAP2120
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: