Provider Demographics
NPI:1033297205
Name:CULLINS, LUKE ST JOHN (PHARM D)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:ST JOHN
Last Name:CULLINS
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:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576
Mailing Address - Country:US
Mailing Address - Phone:907-842-9235
Mailing Address - Fax:907-842-9240
Practice Address - Street 1:6000 KANAKANAK ROAD
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-842-9218
Practice Address - Fax:907-842-9250
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist