Provider Demographics
NPI:1346261476
Name:ANCHORAGE MEDSET PHARMACY INC
Entity Type:Organization
Organization Name:ANCHORAGE MEDSET PHARMACY INC
Other - Org Name:ANCHORAGE MEDSET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:907-770-6081
Mailing Address - Street 1:4101 ARCTIC BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5702
Mailing Address - Country:US
Mailing Address - Phone:907-770-6081
Mailing Address - Fax:907-770-6082
Practice Address - Street 1:4101 ARCTIC BLVD
Practice Address - Street 2:STE B
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5702
Practice Address - Country:US
Practice Address - Phone:907-770-6081
Practice Address - Fax:907-770-6082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AK4123336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1582317Medicaid
1997057OtherPK
AKMS9880Medicaid
AKPH9880Medicaid