Organization
SUSITNA MEDISET SERVICES INC
Active
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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