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General NPI Number Information
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NPI Number | 1235550203
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Entity Type | Individual
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Provider Name | ENOCH RONDUEN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 18600 EAGLE RIVER RD
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City | EAGLE RIVER
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State | AK
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Zip | 99577-8688
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Country | US
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Telephone | 907-694-9786
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Fax |
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Provider Business Mailing Address
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Address Line | 8137 MARSHA LOOP
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City | ANCHORAGE
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State | AK
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Zip | 99507-3290
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Country | US
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Telephone | 808-387-5877
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2119
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License Number State | AK
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