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NPI Code Detail

MEDICARE: GERRY BERUBE RPH

MEDICARE: GERRY BERUBE RPH
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
1183500000XPharmacist559AK

General Provider Information

NPI Number : 1851693345
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERRY BERUBE RPH
Provider Business Mailing Address
First Line : PO BOX 55523
Second Line :
City : NORTH POLE
State : AK
Zip : 99705
Country : US
Telephone Number : 907-488-6702
Fax Number :
Provider Business Practice Location Address
First Line : 301 SANTA CLAUS LN
Second Line :
City : NORTH POLE
State : AK
Zip : 99705-6081
Country : US
Telephone Number : 907-490-2760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2010
Last Update Date : 12/03/2010

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Directions to “ GERRY BERUBE RPH” Practice Location

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