Provider Demographics
NPI:1649517095
Name:DEREN, PATRICE (RPH)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:DEREN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 PIPER ST
Mailing Address - Street 2:PHARMACY DEPT
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4665
Mailing Address - Country:US
Mailing Address - Phone:907-269-7179
Mailing Address - Fax:907-561-0932
Practice Address - Street 1:3700 PIPER ST
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4665
Practice Address - Country:US
Practice Address - Phone:907-269-7179
Practice Address - Fax:907-561-0932
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist