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NPI Code Detail

MEDICARE: ANDREW CLAVELOT

MEDICARE: ANDREW CLAVELOT
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
1183500000XPharmacist101334AK
2183500000XPharmacist34274MT

General Provider Information

NPI Number : 1578938825
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW CLAVELOT
Provider Business Mailing Address
First Line : 1000 E NORTHERN LIGHTS BLVD
Second Line :
City : ANCHORAGE
State : AK
Zip : 99508-4218
Country : US
Telephone Number : 907-264-9633
Fax Number :
Provider Business Practice Location Address
First Line : 1000 E NORTHERN LIGHTS BLVD
Second Line :
City : ANCHORAGE
State : AK
Zip : 99508-4218
Country : US
Telephone Number : 907-264-9633
Fax Number : 907-264-9627
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2015
Last Update Date : 12/10/2015

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Directions to “ ANDREW CLAVELOT ” Practice Location

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