Basic Information
Provider Information
NPI: 1952077125
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FJELD
FirstName: HANNAH
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 4105
Address2:  
City: PORTLAND
State: OR
PostalCode: 972084105
CountryCode: US
TelephoneNumber: 8669071068
FaxNumber: 4259179141
Practice Location
Address1: 1389 HUFFMAN PARK DR STE 202
Address2:  
City: ANCHORAGE
State: AK
PostalCode: 995153534
CountryCode: US
TelephoneNumber: 9072123420
FaxNumber: 9072125550
Other Information
ProviderEnumerationDate: 08/18/2021
LastUpdateDate: 08/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X162270AKY Pharmacy Service ProvidersPharmacist 

No ID Information.


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