Provider Demographics
NPI:1962775064
Name:RATLIFF, JEREMY DAVID (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DAVID
Last Name:RATLIFF
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4456
Mailing Address - Country:US
Mailing Address - Phone:907-365-2033
Mailing Address - Fax:907-365-2027
Practice Address - Street 1:2300 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4456
Practice Address - Country:US
Practice Address - Phone:907-365-2033
Practice Address - Fax:907-365-2027
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1943183500000X
OK14679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist