Organization
LAKE OTIS PHARMACY INC
Active
Other names
LAKE OTIS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY SUTTERLIN RPH (PRESIDENT)
(907) 563-7878
Entity
Organization
Contact information
Practice address
4201 LAKE OTIS PKWY, ANCHORAGE, AK 99508-5214
(907) 563-7878
(907) 563-7879
Mailing address
4201 LAKE OTIS PKWY, ANCHORAGE, AK 99508-5214
(907) 563-7878
(907) 563-7879
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
163
AK
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0201525
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PH0163
—
AK
Enumeration date
07/22/2006
Last updated
03/09/2012
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