Healthcare Provider Details

I. General information

NPI: 1073006557
Provider Name (Legal Business Name): MARY & JOSEPH FOOD AND DRUG COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 N 32ND ST STE C7
PHOENIX AZ
85028-3826
US

IV. Provider business mailing address

10210 N 32ND ST STE C7
PHOENIX AZ
85028-3826
US

V. Phone/Fax

Practice location:
  • Phone: 602-675-0887
  • Fax: 602-610-5844
Mailing address:
  • Phone: 602-675-0887
  • Fax: 602-610-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License NumberY007596
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY JOSEPH YOUKHANA
Title or Position: OWNER
Credential: PHARM. D.
Phone: 602-675-0887