Healthcare Provider Details

I. General information

NPI: 1376757310
Provider Name (Legal Business Name): THREE BEARS ALASKA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 03/07/2023
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8151 E PALMER WASILLA HWY
PALMER AK
99645-8468
US

IV. Provider business mailing address

7362 W. PARKS HWY BOX #814
WASILLA AK
99654-9132
US

V. Phone/Fax

Practice location:
  • Phone: 907-746-3891
  • Fax: 907-746-3892
Mailing address:
  • Phone: 907-357-4311
  • Fax: 907-357-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number433
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1028584
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 2
Identifier433
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerSTATE PHARMACY LICENSE #

VIII. Authorized Official

Name: DAVID ALLEN WEISZ SR.
Title or Position: PRESIDENT/CEO
Credential:
Phone: 907-357-4311