Provider Demographics
NPI:1851486153
Name:SEARHC - JUNEAU PHARMACY
Entity Type:Organization
Organization Name:SEARHC - JUNEAU PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SE VP / 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 1:1200 SALMON CREEK ROAD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-463-4040
Practice Address - Fax:907-463-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK382332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1029012Medicaid
AK0202135OtherNCPDP
AKPH7402Medicaid
AKPH7402Medicaid
AKCL6274Medicaid
AKCL0294Medicaid