Provider Demographics
NPI:1437194206
Name:GREAT LAND INFUSION PHARMACY INC
Entity Type:Organization
Organization Name:GREAT LAND INFUSION PHARMACY INC
Other - Org Name:GREAT LAND INFUSION PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:NOAEILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:907-561-2421
Mailing Address - Street 1:PO BOX 230368, GREAT LAND INFUSION PHARMACY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99523
Mailing Address - Country:US
Mailing Address - Phone:907-561-2421
Mailing Address - Fax:907-868-5154
Practice Address - Street 1:2421 E TUDOR RD
Practice Address - Street 2:STE 107
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1128
Practice Address - Country:US
Practice Address - Phone:907-561-2421
Practice Address - Fax:907-868-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336S0011X
AK4293336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1997065OtherPK
AKPH0429Medicaid
AKMS0429Medicaid
AKPH0429Medicaid