Provider Demographics
NPI:1770671661
Name:SEARHC - HAINES PHARMACY
Entity Type:Organization
Organization Name:SEARHC - HAINES PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEVP / CFO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-463-4000
Mailing Address - Street 1:222 TONGASS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835
Mailing Address - Country:US
Mailing Address - Phone:907-966-2411
Mailing Address - Fax:
Practice Address - Street 1:131 1ST STREET SOUTH
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827
Practice Address - Country:US
Practice Address - Phone:907-766-6300
Practice Address - Fax:907-766-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK365332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL2274Medicaid
AK0202628OtherNCPDP
AKPH2274Medicaid
AK1028735Medicaid
AKPH2274Medicaid