=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396859286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ULMER MEDE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 11/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3858 LAKE STREET STE 5
-----------------------------------------------------
City | HOMER
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-235-7760
-----------------------------------------------------
Fax | 907-235-2897
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3858 LAKE STREET STE 5
-----------------------------------------------------
City | HOMER
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-235-7760
-----------------------------------------------------
Fax | 907-235-2897
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PATRICK MICHAEL MEDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 907-226-3089
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 108984
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------