Provider Demographics
NPI:1083914931
Name:PRESCRIPTION CENTER LLC
Entity Type:Organization
Organization Name:PRESCRIPTION CENTER LLC
Other - Org Name:PRESCRIPTION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIF
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:907-488-8555
Mailing Address - Street 1:167 S SANTA CLAUS LN
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-7702
Mailing Address - Country:US
Mailing Address - Phone:907-488-8555
Mailing Address - Fax:907-488-8556
Practice Address - Street 1:1919 LATHROP ST
Practice Address - Street 2:SUITE 109
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5937
Practice Address - Country:US
Practice Address - Phone:907-452-1514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK473OtherALASKA PHARMACY LICENSE