Healthcare Provider Details

I. General information

NPI: 1659703460
Provider Name (Legal Business Name): MIXTURES PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S VAL VISTA DRIVE BUILDING 1, SUITE 102
GILBERT AZ
85295
US

IV. Provider business mailing address

16515 S 40TH STREET SUITE 123
PHOENIX AZ
85048
US

V. Phone/Fax

Practice location:
  • Phone: 480-300-5279
  • Fax: 480-300-5649
Mailing address:
  • Phone: 480-706-0620
  • Fax: 480-706-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY005671
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LORI LYNN ALLEN
Title or Position: PRESIDENT
Credential: R.PH
Phone: 480-226-1946