Healthcare Provider Details

I. General information

NPI: 1306106984
Provider Name (Legal Business Name): LONG TERM STRATEGIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W WADE LN STE 4
PAYSON AZ
85541-4872
US

IV. Provider business mailing address

107 W WADE LN SUITE 4
PAYSON AZ
85541-4872
US

V. Phone/Fax

Practice location:
  • Phone: 928-468-8299
  • Fax: 928-474-7439
Mailing address:
  • Phone: 928-468-8299
  • Fax: 928-474-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberY005480
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: CRAIG MATHEWS
Title or Position: CEO
Credential:
Phone: 928-951-4913