Healthcare Provider Details

I. General information

NPI: 1871788299
Provider Name (Legal Business Name): MIDWESTERN UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19389 N 59TH AVE
GLENDALE AZ
85308-6500
US

IV. Provider business mailing address

19389 N 59TH AVE
GLENDALE AZ
85308-6500
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-6198
  • Fax: 623-537-6191
Mailing address:
  • Phone: 623-537-6198
  • Fax: 623-537-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number4796
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW J SWEENEY
Title or Position: VP & CFO
Credential:
Phone: 630-515-7307