Healthcare Provider Details

I. General information

NPI: 1578247342
Provider Name (Legal Business Name): SONORAN DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13260 N 94TH DR STE 102
PEORIA AZ
85381-4242
US

IV. Provider business mailing address

1034 W SPUR DR
PHOENIX AZ
85085-6369
US

V. Phone/Fax

Practice location:
  • Phone: 602-509-2863
  • Fax:
Mailing address:
  • Phone: 602-509-2863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. THOMAS SHAW
Title or Position: OWNER/PHARMACIST
Credential: PHARMD
Phone: 602-509-2863