Provider Demographics
NPI:1871694000
Name:FOODLAND SUPER DRUG
Entity type:Organization
Organization Name:FOODLAND SUPER DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:907-586-2012
Mailing Address - Street 1:631 W WILLOUGHBY AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1731
Mailing Address - Country:US
Mailing Address - Phone:907-586-2012
Mailing Address - Fax:
Practice Address - Street 1:631 W WILLOUGHBY AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1731
Practice Address - Country:US
Practice Address - Phone:907-586-2012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK23OtherSTATE PHARMACY LICENSE
0200333OtherNCPDP PHARMACY NUMBER