Healthcare Provider Details

I. General information

NPI: 1588589956
Provider Name (Legal Business Name): BLAZE PHARMACY DBA VERRA RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S IRONWOOD DR STE 104
APACHE JUNCTION AZ
85120-6242
US

IV. Provider business mailing address

850 S IRONWOOD DR STE 104
APACHE JUNCTION AZ
85120-6242
US

V. Phone/Fax

Practice location:
  • Phone: 602-595-9664
  • Fax: 602-595-1376
Mailing address:
  • Phone: 602-595-9664
  • Fax: 602-595-1376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE WOOD
Title or Position: COO
Credential:
Phone: 480-274-3543