Provider Demographics
NPI:1184799777
Name:JUNEAU PHARMACY INC
Entity type:Organization
Organization Name:JUNEAU PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, JUNEAU PHARMACY, INCORPO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACPHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-201-9160
Mailing Address - Street 1:1313 EAST MAPLE STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5708
Mailing Address - Country:US
Mailing Address - Phone:360-685-4270
Mailing Address - Fax:360-205-7504
Practice Address - Street 1:202 FRONT ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1228
Practice Address - Country:US
Practice Address - Phone:907-586-1233
Practice Address - Fax:907-463-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 3336C0003X
AK104795333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158036OtherPK
AK1641961Medicaid