Healthcare Provider Details

I. General information

NPI: 1760782254
Provider Name (Legal Business Name): JARED JORDAN RAWLINGS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44428 STERLING HWY
SOLDOTNA AK
99669-8033
US

IV. Provider business mailing address

47150 WILDBERRY CT
KENAI AK
99611-5946
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-5460
  • Fax:
Mailing address:
  • Phone: 907-953-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1585
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3060
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: