Provider Demographics
NPI:1922253871
Name:ALASKA NORTHERN LIGHTS, INC.
Entity Type:Organization
Organization Name:ALASKA NORTHERN LIGHTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-852-8192
Mailing Address - Street 1:59 DAMONTE RANCH PKWY # B-262
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-1907
Mailing Address - Country:US
Mailing Address - Phone:775-852-8192
Mailing Address - Fax:
Practice Address - Street 1:59 DAMONTE RANCH PKWY # B-262
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-1907
Practice Address - Country:US
Practice Address - Phone:775-852-8192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1007047992332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site