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NPI Code Detail

MEDICARE: SANTA TERESA PHARMACY II LLC

MEDICARE: SANTA TERESA PHARMACY II 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

General Provider Information

NPI Number : 1114692829
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANTA TERESA PHARMACY II LLC
Provider Business Mailing Address
First Line : PO BOX 7649
Second Line :
City : SAN LUIS
State : AZ
Zip : 85349-6815
Country : US
Telephone Number : 928-328-1000
Fax Number : 928-328-1001
Provider Business Practice Location Address
First Line : 1896 E BABBIT LN
Second Line :
City : SAN LUIS
State : AZ
Zip : 85336-7820
Country : US
Telephone Number : 928-328-1000
Fax Number : 928-328-1001
Authorized Official
Title or Position : CEO
Name : RAJ RAKESH SHAH
Credential :
Telephone Number : 626-589-1646
Provider Enumeration Date : 08/13/2021
Last Update Date : 08/13/2021

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Directions to “SANTA TERESA PHARMACY II LLC ” Practice Location

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