Healthcare Provider Details

I. General information

NPI: 1902557275
Provider Name (Legal Business Name): JOHN LELA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
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 TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS025714
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: