Healthcare Provider Details

I. General information

NPI: 1447261078
Provider Name (Legal Business Name): S AND J PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E VIRGINIA AVE STE 120
PHOENIX AZ
85004-1206
US

IV. Provider business mailing address

333 E VIRGINIA AVE STE 120
PHOENIX AZ
85004-1206
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-1196
  • Fax: 602-257-0511
Mailing address:
  • Phone: 602-257-1196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberY001871
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number001871
License Number StateAZ

VIII. Authorized Official

Name: STEVEN GENRICH
Title or Position: OWNER
Credential: DPH
Phone: 602-257-1196