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NPI Code Detail

MEDICARE: SONORAN PHARMACY GROUP INC

MEDICARE: SONORAN PHARMACY GROUP INC
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
23336L0003XLong Term Care PharmacyPH02771NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12152490OTHERPK

General Provider Information

NPI Number : 1285908798
Entity Type Code : Organization
Provider Name (Legal Business Name) : SONORAN PHARMACY GROUP INC
Provider Business Mailing Address
First Line : 1313 E MAPLE ST
Second Line : SUITE 210
City : BELLINGHAM
State : WA
Zip : 98225-5708
Country : US
Telephone Number : 360-685-4270
Fax Number : 360-205-7504
Provider Business Practice Location Address
First Line : 4101 WAGON TRAIL AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-4426
Country : US
Telephone Number : 702-576-9545
Fax Number : 702-946-0353
Authorized Official
Title or Position : GREFFIER
Name : BLAIR WHITNEY
Credential :
Telephone Number : 360-543-7376
Provider Enumeration Date : 03/01/2012
Last Update Date : 11/07/2016

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