Healthcare Provider Details

I. General information

NPI: 1710216544
Provider Name (Legal Business Name): ALASKA ISLAND COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CHURCH ST
WRANGELL AK
99929
US

IV. Provider business mailing address

PO BOX 1231
WRANGELL AK
99929-1231
US

V. Phone/Fax

Practice location:
  • Phone: 907-874-5005
  • Fax: 907-874-4719
Mailing address:
  • Phone: 907-874-5005
  • Fax: 907-874-4719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number471
License Number StateAK

VIII. Authorized Official

Name: MARK WALKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 907-874-2373