Healthcare Provider Details

I. General information

NPI: 1528436292
Provider Name (Legal Business Name): REEHS ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17301 E SPRING VALLEY RD STE B
MAYER AZ
86333-4263
US

IV. Provider business mailing address

38803 N COURAGE CT
ANTHEM AZ
85086-2791
US

V. Phone/Fax

Practice location:
  • Phone: 928-830-9393
  • Fax:
Mailing address:
  • Phone: 928-830-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberY006537
License Number StateAZ

VIII. Authorized Official

Name: MRS. RONDA ELAINE HICKS
Title or Position: PHARMACIST/OWNER
Credential: RPH
Phone: 928-830-9393