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NPI Code Detail

MEDICARE: BANNER PHARMACY SERVICES LLC

MEDICARE: BANNER PHARMACY SERVICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyY005805AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22145016OTHERPK

General Provider Information

NPI Number : 1083035117
Entity Type Code : Organization
Provider Name (Legal Business Name) : BANNER PHARMACY SERVICES LLC
Provider Business Mailing Address
First Line : 2901 N CENTRAL AVE STE 160
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2702
Country : US
Telephone Number : 602-747-4000
Fax Number :
Provider Business Practice Location Address
First Line : 1400 S DOBSON RD
Second Line :
City : MESA
State : AZ
Zip : 85202-4707
Country : US
Telephone Number : 480-412-4250
Fax Number : 480-412-4252
Authorized Official
Title or Position : CEO
Name : RUSSELL FUNK
Credential :
Telephone Number : 602-747-4000
Provider Enumeration Date : 12/16/2013
Last Update Date : 04/15/2026

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Directions to “BANNER PHARMACY SERVICES LLC ” Practice Location

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