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NPI Code Detail

MEDICARE: NORTHERN LIGHTS PHARMACY, INC.

MEDICARE: NORTHERN LIGHTS PHARMACY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336L0003XLong Term Care Pharmacy

General Provider Information

NPI Number : 1205088747
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN LIGHTS PHARMACY, INC.
Provider Business Mailing Address
First Line : 4121 W DRAVUS ST
Second Line :
City : SEATTLE
State : WA
Zip : 98199-2449
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9100 CENTENNIAL CIR
Second Line :
City : ANCHORAGE
State : AK
Zip : 99504-1480
Country : US
Telephone Number : 907-333-8100
Fax Number :
Authorized Official
Title or Position : CHAIRMAN/CEO
Name : MR. ANDREW TURNER
Credential :
Telephone Number : 206-491-4202
Provider Enumeration Date : 10/15/2008
Last Update Date : 10/15/2008

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