Provider Demographics
NPI:1467564443
Name:INLET PHARMACY GROUP INC.
Entity Type:Organization
Organization Name:INLET PHARMACY GROUP INC.
Other - Org Name:SOLDOTNA PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFFRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-262-3800
Mailing Address - Street 1:299 N BINKLEY ST
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7523
Mailing Address - Country:US
Mailing Address - Phone:907-262-3800
Mailing Address - Fax:907-262-6429
Practice Address - Street 1:299 N BINKLEY
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:907-262-3800
Practice Address - Fax:907-262-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0003X
AK3783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1682491Medicaid
2147566OtherPK
0201436OtherNCPDP PROVIDER IDENTIFICATION NUMBER