Provider Demographics
NPI:1811501679
Name:PROFESSIONAL PHARMACY LLC
Entity type:Organization
Organization Name:PROFESSIONAL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:907-452-2556
Mailing Address - Street 1:1001 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4948
Mailing Address - Country:US
Mailing Address - Phone:907-452-2556
Mailing Address - Fax:907-451-8314
Practice Address - Street 1:1001 NOBLE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4948
Practice Address - Country:US
Practice Address - Phone:907-452-2556
Practice Address - Fax:907-451-8314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy