Healthcare Provider Details

I. General information

NPI: 1609251537
Provider Name (Legal Business Name): ALLERGYRX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 E PALM ST BLDG 5
MESA AZ
85215-1118
US

IV. Provider business mailing address

3960 E PALM ST BLDG 5
MESA AZ
85215-1118
US

V. Phone/Fax

Practice location:
  • Phone: 480-339-2382
  • Fax: 480-820-1833
Mailing address:
  • Phone: 480-339-2382
  • Fax: 480-820-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberY006414
License Number StateAZ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DANIEL DEE
Title or Position: PHARMACIST
Credential: PHARM.D
Phone: 480-299-5595