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General NPI Number Information
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NPI Number | 1396953964
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Entity Type | Individual
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Provider Name | FREDDY RUKEMA KANIKI RPH
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 439 5TH & GRIZZLY
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City | KOTZEBUE
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State | AK
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Zip | 99752
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Country | US
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Telephone | 907-442-7182
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Fax |
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Provider Business Mailing Address
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Address Line | 210 LANE AVE
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City | PORTLAND
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State | ME
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Zip | 04103-1249
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Country | US
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Telephone | 207-797-4489
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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 | 1675
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License Number State | AK
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