Healthcare Provider Details

I. General information

NPI: 1588764534
Provider Name (Legal Business Name): STIKINE DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FRONT ST
WRANGELL AK
99929
US

IV. Provider business mailing address

PO BOX 471
WRANGELL AK
99929-0471
US

V. Phone/Fax

Practice location:
  • Phone: 907-874-3422
  • Fax: 907-874-3193
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number374
License Number StateAK

VIII. Authorized Official

Name: STEPHEN COLE
Title or Position: OWNER
Credential:
Phone: 907-874-3422