Provider Demographics
NPI:1528126653
Name:PIONEER HOMES PHARMACY
Entity type:Organization
Organization Name:PIONEER HOMES PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:907-343-7294
Mailing Address - Street 1:923 W 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-4306
Mailing Address - Country:US
Mailing Address - Phone:907-343-7294
Mailing Address - Fax:907-343-7270
Practice Address - Street 1:923 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4306
Practice Address - Country:US
Practice Address - Phone:907-343-7294
Practice Address - Fax:907-343-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPH9858Medicaid
AK6690950001Medicare NSC