Healthcare Provider Details

I. General information

NPI: 1649334442
Provider Name (Legal Business Name): NORTH COUNTRY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 NORTH 4TH STREET
FLAGSTAFF AZ
86004
US

IV. Provider business mailing address

2920 NORTH 4TH STREET
FLAGSTAFF AZ
86004
US

V. Phone/Fax

Practice location:
  • Phone: 928-213-0589
  • Fax: 928-213-0597
Mailing address:
  • Phone: 928-213-0589
  • Fax: 928-213-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number3287
License Number StateAZ

VIII. Authorized Official

Name: ANN M ROGGENBUCK
Title or Position: CEO
Credential:
Phone: 928-774-8325