Provider Demographics
NPI:1063590586
Name:AK PHARMACY MANAGEMENT LLC
Entity type:Organization
Organization Name:AK PHARMACY MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PIC
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-452-2328
Mailing Address - Street 1:1867 AIRPORT WAY
Mailing Address - Street 2:STE 105
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4054
Mailing Address - Country:US
Mailing Address - Phone:907-452-2328
Mailing Address - Fax:907-452-8073
Practice Address - Street 1:1867 AIRPORT WAY
Practice Address - Street 2:STE 105
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4054
Practice Address - Country:US
Practice Address - Phone:907-452-2328
Practice Address - Fax:907-452-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHAR495333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146752OtherPK
1147610001Medicare ID - Type Unspecified
0200624OtherNABP NUMBER
BM4722965OtherDEA NUMBER
AKMS0268Medicaid