| Organization Name: | HSWL FO KODIAK DET KETCHIKAN |
| NPI Number: | 1285948877 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT BIDWELL (CLINIC ADMINISTRATOR) |
| Mailing Address: | 1300 Stedman St Ketchikan |
| State: | AK US |
| Postal Code: | 999016661 |
| Phone Number: | 9072280320 |
| Fax Number: | 9072280255 |
| NPI Enumeration Date: | 08/06/2010 |
| NPI Last Update Date: | 08/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Military/U.S. Coast Guard Pharmacy |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |