Provider Demographics
NPI:1992278097
Name:ALASKA UROLOGICAL INSTITUTE PC (PHARMACY)
Entity type:Organization
Organization Name:ALASKA UROLOGICAL INSTITUTE PC (PHARMACY)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-276-2844
Mailing Address - Street 1:188 W NORTHERN LIGHTS BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3984
Mailing Address - Country:US
Mailing Address - Phone:907-276-2803
Mailing Address - Fax:
Practice Address - Street 1:188 W NORTHERN LIGHTS BLVD STE 800
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3984
Practice Address - Country:US
Practice Address - Phone:907-276-2803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALASKA UROLOGICAL INSTITUTE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-10
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy