Provider Demographics
NPI:1376757310
Name:THREE BEARS ALASKA INC.
Entity Type:Organization
Organization Name:THREE BEARS ALASKA INC.
Other - Org Name:THREE BEARS PHARMACY #60
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WEISZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:907-357-4311
Mailing Address - Street 1:7362 W. PARKS HWY
Mailing Address - Street 2:BOX #814
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-9132
Mailing Address - Country:US
Mailing Address - Phone:907-357-4311
Mailing Address - Fax:907-357-4312
Practice Address - Street 1:8151 E PALMER WASILLA HWY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8468
Practice Address - Country:US
Practice Address - Phone:907-746-3891
Practice Address - Fax:907-746-3892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK433333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1028584Medicaid
AK433OtherSTATE PHARMACY LICENSE #
AK433OtherSTATE PHARMACY LICENSE #
AKPH0421Medicaid