Organization
SUSITNA MEDISET SERVICES INC
Active
Other names
SUSITNA MEDISET SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MUNDELL RPH (EXECT VP)
(907) 373-7933
Entity
Organization
Contact information
Practice address
1751 E GARDNER WAY, STE F, WASILLA, AK 99654-6564
(907) 352-4306
(907) 357-7590
Mailing address
1751 E GARDNER WAY, STE F, WASILLA, AK 99654-6564
(907) 352-4306
(907) 373-7939
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
438
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0227810
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PH0267
—
AK
Enumeration date
09/10/2007
Last updated
03/07/2012
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