Healthcare Provider Details

I. General information

NPI: 1851607444
Provider Name (Legal Business Name): 1ST CARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S WATSON RD STE 104A
BUCKEYE AZ
85326-6264
US

IV. Provider business mailing address

1300 S WATSON RD STE 104A
BUCKEYE AZ
85326-6264
US

V. Phone/Fax

Practice location:
  • Phone: 623-251-3201
  • Fax: 623-251-3205
Mailing address:
  • Phone: 623-251-3201
  • Fax: 623-251-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY005289
License Number StateAZ

VIII. Authorized Official

Name: LAMECK NYAKWEBA
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 623-932-9800