NPI 1013603117 · live from the CMS NPI Registry
Ian Cirasunda Dettman, PharmD
Pharmacist in Jber, AK. National Provider Identifier 1013603117, active.
NPI record
| NPI | 1013603117 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Pharmacist 183500000X |
| Practice location | 5955 Zeamer Ave, Jber, AK 99506 |
| Practice phone | 907-580-6800 |
| Enumerated | April 12, 2023 |
| Last updated | October 25, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pharmacist primary | 183500000X | PHA.0024591 (CO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.