Healthcare Provider Details

I. General information

NPI: 1467099986
Provider Name (Legal Business Name): TODD LEROY REX RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26300 N NORTERRA PKWY
PHOENIX AZ
85085-8210
US

IV. Provider business mailing address

26300 N NORTERRA PKWY
PHOENIX AZ
85085-8210
US

V. Phone/Fax

Practice location:
  • Phone: 928-251-7075
  • Fax: 928-251-7076
Mailing address:
  • Phone: 928-251-7075
  • Fax: 928-251-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14100
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26019884A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: