Organization
LAKE OTIS PHARMACY INC
Active
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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