Provider Demographics
NPI:1699818211
Name:I CARE PHARMACY
Entity Type:Organization
Organization Name:I CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:907-277-0644
Mailing Address - Street 1:403 W NORTHERN LIGHTS BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:403 W NORTHERN LIGHTS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2550
Practice Address - Country:US
Practice Address - Phone:907-277-0644
Practice Address - Fax:907-277-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK427333600000X
3336C0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS6413Medicaid
AKPH6413Medicaid
AKPH5335Medicaid
0227113OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AKPH6413Medicaid