Organization
PROVIDENCE HEALTH SYSTEM WASHINGTON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Other names
Providence Apothecary
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 525-5392
Entity
Organization
Contact information
Practice address
920 COMPASSION CIR, ANCHORAGE, AK 99504-1645
(907) 212-9200
(907) 212-9280
Mailing address
3760 PIPER ST, SUITE 1061, ANCHORAGE, AK 99508-4683
(907) 212-0256
(907) 212-6547
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
352
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1028426
UPDATED MEDICAID ID
AK
Enumeration date
03/06/2007
Last updated
03/04/2024
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