Healthcare Provider Details

I. General information

NPI: 1972139699
Provider Name (Legal Business Name): PACIFIC HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CANAL STREET
SAIPAN MP
96950
US

IV. Provider business mailing address

PO BOX 505089
SAIPAN MP
96950-4314
US

V. Phone/Fax

Practice location:
  • Phone: 670-286-6698
  • Fax:
Mailing address:
  • Phone: 670-286-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA WISE
Title or Position: GENERAL MANAGER
Credential: PHARM.D.
Phone: 670-286-6698