Provider Demographics
NPI:1710480009
Name:GIRDWOOD DRUG INC
Entity Type:Organization
Organization Name:GIRDWOOD DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
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 1:158 HOLMGREN
Mailing Address - Street 2:STE 103
Mailing Address - City:GIRDWOOD
Mailing Address - State:AK
Mailing Address - Zip Code:99587
Mailing Address - Country:US
Mailing Address - Phone:907-205-4270
Mailing Address - Fax:907-262-6429
Practice Address - Street 1:158 HOLMGREN
Practice Address - Street 2:STE 103
Practice Address - City:GIRDWOOD
Practice Address - State:AK
Practice Address - Zip Code:99587
Practice Address - Country:US
Practice Address - Phone:907-205-4270
Practice Address - Fax:907-262-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AK1314793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176430OtherPK