Organization
BANNER HEALTH
Active
Other names
Fairbanks Infusion Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN EDWARD COTTER RPH (DIRECTOR OF PHARMACY)
(907) 458-5621
Entity
Organization
Contact information
Practice address
1650 COWLES ST, DEPT 41B, FAIRBANKS, AK 99701-5925
(907) 458-5621
(907) 458-5622
Mailing address
1650 COWLES ST, DEPT 41B, FAIRBANKS, AK 99701-5925
(907) 458-5621
(907) 458-5622
Taxonomy
Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
Primary
423
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0227721
NCPDP
—
01
—
423
STATE PHARMACY LICENSE
AK
05
—
PH7755
—
AK
Enumeration date
08/13/2007
Last updated
03/07/2023
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