Healthcare Provider Details

I. General information

NPI: 1982532727
Provider Name (Legal Business Name): ELK RIDGE FLAGSTAFF PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 N 4TH ST
FLAGSTAFF AZ
86004-1816
US

IV. Provider business mailing address

2920 N 4TH ST
FLAGSTAFF AZ
86004-1816
US

V. Phone/Fax

Practice location:
  • Phone: 928-522-9403
  • Fax: 928-522-9701
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: MELVA A GONZALEZ
Title or Position: PHARMACY COORDINATOR
Credential:
Phone: 520-670-3813