Healthcare Provider Details

I. General information

NPI: 1093608846
Provider Name (Legal Business Name): PEGASUS SUPPLY CHAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 W SABLE AVE
APACHE JUNCTION AZ
85120-0035
US

IV. Provider business mailing address

2717 W SABLE AVE
APACHE JUNCTION AZ
85120-0035
US

V. Phone/Fax

Practice location:
  • Phone: 314-556-8039
  • Fax:
Mailing address:
  • Phone: 314-556-8039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MR. BRANDEN D GRIFFIN
Title or Position: CEO
Credential:
Phone: 314-556-8039