MEDICARE: PAGE HOSPITAL PHARMACY

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
1	3336I0012X	Institutional Pharmacy	1497	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0308797	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1306988209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAGE HOSPITAL PHARMACY

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	:	501 N NAVAJO
Second Line	:
City	:	PAGE
State	:	AZ
Zip	:	86040-1447
Country	:	US
Telephone Number	:	928-645-2424
Fax Number	:	928-645-0154

Authorized Official
Title or Position	:	CFO
Name	:	DENNIS LARAWAY
Credential	:
Telephone Number	:	602-747-4000

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	12/22/2021

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Directions to “PAGE HOSPITAL PHARMACY ” Practice Location

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