Healthcare Provider Details

I. General information

NPI: 1255246443
Provider Name (Legal Business Name): ASPEN CORNER PHARMACY AND REFILLERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S REGENT ST STE 308
FLAGSTAFF AZ
86001-5940
US

IV. Provider business mailing address

320 S REGENT ST STE 308
FLAGSTAFF AZ
86001-5940
US

V. Phone/Fax

Practice location:
  • Phone: 623-693-2786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KYLE KENNEDY
Title or Position: SOLE MEMBER
Credential:
Phone: 623-693-2786