Healthcare Provider Details

I. General information

NPI: 1154094779
Provider Name (Legal Business Name): ALCHEMY APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W PARK AVE
ASH FORK AZ
86320
US

IV. Provider business mailing address

419 S 3RD ST
WILLIAMS AZ
86046-2448
US

V. Phone/Fax

Practice location:
  • Phone: 855-277-5901
  • Fax: 833-731-0353
Mailing address:
  • Phone: 855-277-5901
  • Fax: 833-731-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL KNIGHT
Title or Position: OWNER, AUTHORIZED OFFICIAL
Credential: FNP-BC
Phone: 855-277-5901