Provider Demographics
NPI:1235480120
Name:YUKON KUSKOKWIM HEALTH CORPORTATION
Entity Type:Organization
Organization Name:YUKON KUSKOKWIM HEALTH CORPORTATION
Other - Org Name:YKHC CLINIC DISPENSED PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:907-543-6992
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0287
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 CHIEF EDDIE HOFFMAN HWY
Practice Address - Street 2:YKHC PHARMACY DEPARTMENT
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0287
Practice Address - Country:US
Practice Address - Phone:907-543-6992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
0202212OtherNABP
AKPH4141Medicaid