Healthcare Provider Details

I. General information

NPI: 1528202215
Provider Name (Legal Business Name): FIRST ROYAL CARE CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6828 E BROWN RD STE 101
MESA AZ
85207-3761
US

IV. Provider business mailing address

6828 E BROWN RD STE 101
MESA AZ
85207-3761
US

V. Phone/Fax

Practice location:
  • Phone: 480-218-2236
  • Fax: 480-471-6005
Mailing address:
  • Phone: 480-218-2236
  • Fax: 480-471-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY006079
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2120042
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: DAWN HOANG
Title or Position: OWNER
Credential:
Phone: 480-204-1442