Healthcare Provider Details

I. General information

NPI: 1841531126
Provider Name (Legal Business Name): NEWSPRING PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 W MCDOWELL RD
AVONDALE AZ
85392-5960
US

IV. Provider business mailing address

14362 N FRANK LLOYD WRIGHT BLVD SUITE 1000
SCOTTSDALE AZ
85260-8846
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-9800
  • Fax: 623-932-9817
Mailing address:
  • Phone: 623-552-6848
  • Fax: 623-552-6957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY005594
License Number StateAZ

VIII. Authorized Official

Name: LUCAS NYABERO
Title or Position: C.E.O
Credential:
Phone: 623-552-8119