Healthcare Provider Details

I. General information

NPI: 1528251311
Provider Name (Legal Business Name): ARIZONA MEDICAL INFUSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20650 N 29TH PL SUITE 105
PHOENIX AZ
85050-4782
US

IV. Provider business mailing address

20650 N 29TH PL SUITE 105
PHOENIX AZ
85050-4782
US

V. Phone/Fax

Practice location:
  • Phone: 602-788-3400
  • Fax: 602-788-3405
Mailing address:
  • Phone: 602-788-3400
  • Fax: 602-788-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License NumberY004697
License Number StateAZ

VIII. Authorized Official

Name: ANTHONY SAMMARTINO
Title or Position: DIRECTOR OF PHARMACY
Credential: R.PH.
Phone: 602-788-3400