Organization
PROFESSIONAL HOME IV INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES KEVIN HENDERSON RPH (OWNER)
(907) 262-8737
Entity
Organization
Contact information
Practice address
182 S BIRCH ST, SOLDOTNA, AK 99669-8020
(907) 262-8737
(907) 260-7405
Mailing address
182 S BIRCH ST, SOLDOTNA, AK 99669-8020
(907) 262-8737
(907) 260-7405
Taxonomy
Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
Primary
490
AK
3336L0003X
Long Term Care Pharmacy
PHAR490
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021642
—
AK
05
—
1028530
—
AK
05
—
1619615
—
AK
05
—
MS1723
—
AK
05
—
PH0246
—
AK
Enumeration date
07/04/2006
Last updated
09/27/2022
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