Provider Demographics
NPI:1598042392
Name:RASMUSSEN, JOHN WALLACE (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WALLACE
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 WINTERCREST CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1996
Mailing Address - Country:US
Mailing Address - Phone:907-748-9789
Mailing Address - Fax:907-344-1297
Practice Address - Street 1:330 W DIMOND BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1903
Practice Address - Country:US
Practice Address - Phone:907-276-7116
Practice Address - Fax:907-344-1297
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA 403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist