Organization
PROFESSIONAL PHARMACY LLC
Active
Organization
PROFESSIONAL PHARMACY LLC
Active
Other names
Professional Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEIF JOSEPH HOLM PHARMD (VICE-PRESIDENT/PHARMACIST)
(907) 488-8555
Entity
Organization
Contact information
Practice address
1001 NOBLE ST, FAIRBANKS, AK 99701-4922
(907) 452-2556
Mailing address
167 S. SANTA CLAUS LANE, NORTH POLE, AK 99705
(907) 488-8555
(907) 488-8556
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
474
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
474
STATE PHARMACY LICENSE
AK
Enumeration date
10/18/2010
Last updated
10/18/2010
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