Provider Demographics
NPI:1912416579
Name:PHARMACY PARTNERS, LLC
Entity Type:Organization
Organization Name:PHARMACY PARTNERS, LLC
Other - Org Name:OUR DOCTOR'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED AGENT / PIC
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STOLL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:907-376-5700
Mailing Address - Street 1:3831 E BLUE LUPINE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-376-5700
Mailing Address - Fax:907-376-5710
Practice Address - Street 1:3831 E BLUE LUPINE DR
Practice Address - Street 2:SUITE A
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-376-5700
Practice Address - Fax:907-376-5710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMACY PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1154733336L0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1655351Medicaid
AK183913OtherALASKA PHARMACY LICENSE
AK1699303Medicaid