MEDICARE: NORTH POLE PRESCRIPTION LABORATORY 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
1	3336C0002X	Clinic Pharmacy

General Provider Information

NPI Number	:	1467051292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH POLE PRESCRIPTION LABORATORY INC

Provider Business Mailing Address
First Line	:	167 S SANTA CLAUS LN
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-7755
Country	:	US
Telephone Number	:	907-488-8555
Fax Number	:	907-488-8556

Provider Business Practice Location Address
First Line	:	167 S SANTA CLAUS LN
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-7755
Country	:	US
Telephone Number	:	907-488-8555
Fax Number	:	907-488-8556

Authorized Official
Title or Position	:	PIC
Name	:	DR. HAJNALKA NEMETH
Credential	:	PHARMD
Telephone Number	:	907-488-8555

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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