Active NPI
Freddy Rukema Kaniki, RPH
- Pharmacist
- Kotzebue, AK
National Provider Identifier
1396953964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 1675
- Practice address
- 439 5TH & Grizzly
Kotzebue, AK 99752 - Phone
- (907) 442-7182
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 1675 | AK | Primary |
Addresses
Primary practice location
439 5TH & Grizzly
Kotzebue, AK 99752
Mailing address
210 Lane Ave
Portland, ME 04103-1249
Phone (207) 797-4489
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1675 | AK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bethesda Treatment and Recovery Center LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Methadone Clinic
- Anchorage, AK
- NPI 1205623931
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396953964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 LANE AVE",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041031249",
"telephone_number": "207-797-4489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "439 5TH & GRIZZLY",
"city": "KOTZEBUE",
"state": "AK",
"postal_code": "99752",
"telephone_number": "907-442-7182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANIKI",
"first_name": "FREDDY",
"middle_name": "RUKEMA",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AK",
"license": "1675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kotzebue, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.