MEDICARE: BEKILAH PHARMACY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1558231837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEKILAH PHARMACY LLC

Provider Business Mailing Address
First Line	:	1010 E PENNSYLVANIA ST STE 206
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85714-1665
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 E PENNSYLVANIA ST STE 206
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85714-1665
Country	:	US
Telephone Number	:	520-461-5061
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIBROAD AMINAZONG
Credential	:	PHARMD
Telephone Number	:	520-561-5061

Provider Enumeration Date	:	11/11/2025
Last Update Date	:	02/10/2026

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Directions to “BEKILAH PHARMACY LLC ” Practice Location

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