=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053232496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERIDIAN THERAPEUTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2026
-----------------------------------------------------
Last Update Date | 07/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 432 S ALASKA ST STE 1A
-----------------------------------------------------
City | PALMER
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99645-6338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-746-7836
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4931 E MAYFLOWER LN STE 1
-----------------------------------------------------
City | WASILLA
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99654-7759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-746-7836
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DYLAN DRAHOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 907-746-7836
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------