Provider Demographics
NPI:1396859286
Name:ULMER MEDE, INC.
Entity Type:Organization
Organization Name:ULMER MEDE, INC.
Other - Org Name:ULMER'S DRUG & HARDWARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-226-3089
Mailing Address - Street 1:3858 LAKE STREET
Mailing Address - Street 2:STE 5
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603
Mailing Address - Country:US
Mailing Address - Phone:907-235-7760
Mailing Address - Fax:907-235-2897
Practice Address - Street 1:3858 LAKE STREET
Practice Address - Street 2:STE 5
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603
Practice Address - Country:US
Practice Address - Phone:907-235-7760
Practice Address - Fax:907-235-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1089843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0201082OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AK1650751Medicaid