Provider Demographics
NPI:1073078721
Name:MA, NORMAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:MA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 LUSARDI POINT CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3153
Mailing Address - Country:US
Mailing Address - Phone:415-374-0727
Mailing Address - Fax:
Practice Address - Street 1:1650 W NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3340
Practice Address - Country:US
Practice Address - Phone:415-374-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60877008183500000X
AK140545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist