Provider Demographics
NPI:1992033575
Name:FRONTIER GROUP INC
Entity Type:Organization
Organization Name:FRONTIER GROUP INC
Other - Org Name:FRONTIER MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-258-8618
Mailing Address - Street 1:907 E DOWLING RD STE 26
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1427
Mailing Address - Country:US
Mailing Address - Phone:907-258-8618
Mailing Address - Fax:907-563-9291
Practice Address - Street 1:2217 E TUDOR RD STE 18
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1068
Practice Address - Country:US
Practice Address - Phone:907-222-0668
Practice Address - Fax:907-334-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X
AK4823336L0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123038OtherPK