Provider Demographics
NPI:1750392320
Name:FAMILY PHARMACY
Entity type:Organization
Organization Name:FAMILY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SREBERNAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-694-7007
Mailing Address - Street 1:11432 BUSINESS BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7740
Mailing Address - Country:US
Mailing Address - Phone:907-694-7007
Mailing Address - Fax:907-694-7051
Practice Address - Street 1:11432 BUSINESS BLVD STE 10
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7740
Practice Address - Country:US
Practice Address - Phone:907-694-7007
Practice Address - Fax:907-694-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AK3043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPH7976Medicaid
1996885OtherPK