Provider Demographics
NPI:1396045191
Name:MAUER, JOSEPH KEVIN (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KEVIN
Last Name:MAUER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 MILL BAY RD
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6638
Mailing Address - Country:US
Mailing Address - Phone:907-481-1560
Mailing Address - Fax:907-481-1519
Practice Address - Street 1:2685 MILL BAY RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6638
Practice Address - Country:US
Practice Address - Phone:907-481-1560
Practice Address - Fax:907-481-1519
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist