Healthcare Provider Details

I. General information

NPI: 1295887552
Provider Name (Legal Business Name): MIXTURES PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16515 S 40TH ST STE 123
PHOENIX AZ
85048-0559
US

IV. Provider business mailing address

16515 S 40TH ST STE 123
PHOENIX AZ
85048-0559
US

V. Phone/Fax

Practice location:
  • Phone: 480-706-0620
  • Fax: 480-706-0489
Mailing address:
  • Phone: 480-706-0620
  • Fax: 480-706-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberYO3896
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number3986
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3896
License Number StateAZ

VIII. Authorized Official

Name: LORI ALLEN
Title or Position: PHARMACIST OWNER
Credential: RPH
Phone: 480-706-0620