MEDICARE: JOHN EDWARD PACEY R. PH.

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	183500000X	Pharmacist	03-3-10561	OH
2	183500000X	Pharmacist	10246	NV
3	183500000X	Pharmacist	S016943	AZ

General Provider Information

NPI Number	:	1669547121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN EDWARD PACEY R. PH.

Provider Business Mailing Address
First Line	:	801 E WALTANN LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-3507
Country	:	US
Telephone Number	:	602-354-5922
Fax Number	:

Provider Business Practice Location Address
First Line	:	3141 N 3RD AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4351
Country	:	US
Telephone Number	:	602-664-5494
Fax Number	:	602-664-5466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	03/18/2009

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