MEDICARE: LEDJHA EKSTEDT

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	3336C0003X	Community/Retail Pharmacy	PHAR498	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487118402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEDJHA EKSTEDT

Provider Business Mailing Address
First Line	:	4101 ARCTIC BLVD STE B
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-5702
Country	:	US
Telephone Number	:	907-770-6081
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 ARCTIC BLVD STE B
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-5702
Country	:	US
Telephone Number	:	907-770-6081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	01/23/2019

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Directions to “ LEDJHA EKSTEDT ” Practice Location

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