Healthcare Provider Details

I. General information

NPI: 1316997083
Provider Name (Legal Business Name): AVONDALE NEIGHBORHOOD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 W MCDOWELL RD BLDG. A STE. 110
AVONDALE AZ
85392-5960
US

IV. Provider business mailing address

10750 W MCDOWELL RD BLDG. A STE. 110
AVONDALE AZ
85392-5960
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-9800
  • Fax: 623-932-9817
Mailing address:
  • Phone: 623-932-9800
  • Fax: 623-932-9817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY004448
License Number StateAZ

VIII. Authorized Official

Name: LAMECK NYAKWEBA
Title or Position: OWNER
Credential: RPH
Phone: 602-430-9646