NPIMap

Organization Active NPI

Banner Health

  • Home Infusion Therapy Pharmacy
  • Fairbanks, AK
National Provider Identifier
1003008277
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
License
423 Issued in AK
Legal business name
BANNER HEALTH
Practice address
1650 Cowles St
Dept 41B
Fairbanks, AK 99701-5925
Phone
(907) 458-5621
Fax
(907) 458-5622
NPI assigned
Aug 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John Edward Cotter, RPH
Title
Director of Pharmacy
Phone
(907) 458-5621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Therapy Pharmacy 3336H0001X 423 AK Primary

Addresses

Primary practice location

1650 Cowles St
Dept 41B
Fairbanks, AK 99701-5925

Mailing address

1650 Cowles St
Dept 41B
Fairbanks, AK 99701-5925
Phone (907) 458-5621

Other identifiers 3

IdentifierTypeStateIssuer
PH7755MedicaidAK
423OtherAKSTATE PHARMACY LICENSE
0227721OtherNCPDP

Other names 1

  • Fairbanks Infusion Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Banner Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1650 Cowles St
#41B
Fairbanks, AK 99701
Phone (907) 458-5621

Ownership & related parties

Subparts reporting this organization as parent 7

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1003008277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "address_2": "DEPT 41B",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015925",
            "telephone_number": "907-458-5621",
            "fax_number": "907-458-5622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "address_2": "DEPT 41B",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015925",
            "telephone_number": "907-458-5621",
            "fax_number": "907-458-5622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "COTTER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "907-458-5621",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "AK",
            "license": "423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PH7755",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHARMACY LICENSE",
            "identifier": "423",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0227721",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairbanks Infusion Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.