Provider Demographics
NPI:1053522482
Name:JUNEAU DRUG AT MINERS COVE
Entity type:Organization
Organization Name:JUNEAU DRUG AT MINERS COVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:SHIRLEY
Authorized Official - Last Name:REGISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-586-5712
Mailing Address - Street 1:700 S. FRANKLIN ST.
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-586-5712
Mailing Address - Fax:907-586-2708
Practice Address - Street 1:700 S. FRANKLIN ST.
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-586-5712
Practice Address - Fax:907-586-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy