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General NPI Number Information
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NPI Number | 1003973041
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Entity Type | Organization
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Legal Business Name | KODIAK AREA NATIVE ASSOCIATION PHARMACY
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 3449 E REZANOF DR
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City | KODIAK
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State | AK
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Zip | 99615-6952
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Country | US
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Telephone | 907-486-9860
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Fax | 907-486-9895
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Provider Business Mailing Address
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Address Line | 3449 E REZANOF DR
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City | KODIAK
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State | AK
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Zip | 99615-6952
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Country | US
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Telephone | 907-486-9860
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Fax | 907-486-9895
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL PFEFFER
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Credential | CEO
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Telephone | 907-486-9801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number | 107
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License Number State | AK
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