| NPI | 1982625943 |
|---|---|
| Doing Business As | LAKE OTIS PHARMACY |
| Entity Type | Organization |
| Authorized Contact | WESLEY SUTTERLIN President 907-563-7878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AK 163) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2012-03-09 |