Provider Demographics
NPI:1073279840
Name:STATE OF ALASKA DEPT. OF CORRECTIONS PHARMACY
Entity Type:Organization
Organization Name:STATE OF ALASKA DEPT. OF CORRECTIONS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPA
Authorized Official - Phone:907-269-7392
Mailing Address - Street 1:550 W. 7TH AVE
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501
Mailing Address - Country:US
Mailing Address - Phone:907-269-7337
Mailing Address - Fax:097-269-7335
Practice Address - Street 1:550 W. 7TH AVE
Practice Address - Street 2:SUITE 1260
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501
Practice Address - Country:US
Practice Address - Phone:907-269-7337
Practice Address - Fax:097-269-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy