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Provider Information for 1487118402


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LEDJHA EKSTEDT


Sex: Female

NPI: 1487118402
Last Updated: 2019-01-23
Certification Date:

Details

NameValue
NPI1487118402
Enumeration Date2019-01-23
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 4101 ARCTIC BLVD STE B
ANCHORAGE, AK 99503-5702
United States

Phone: 907-770-6081 | Fax:
 
Primary Practice Address 4101 ARCTIC BLVD STE B
ANCHORAGE, AK 99503-5702
United States

Phone: 907-770-6081 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDAK1619401
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyAKPHAR498