Organization
PROVIDENCE HEALTH & SERVICES WASHINGTON
Active
Other names
PROVIDENCE KODIAK ISLAND MEDICAL CENTER RETAIL
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1915 E REZANOF DR, KODIAK, AK 99615-6602
(907) 486-9550
Mailing address
PO BOX 3706, PORTLAND, OR 97208-3706
(907) 486-9550
(907) 486-9553
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
285
AK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Enumeration date
12/15/2005
Last updated
05/13/2025
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