Healthcare Provider Details

I. General information

NPI: 1184909707
Provider Name (Legal Business Name): FAVOUR ENTERPRISES L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 N 2ND ST
PHOENIX AZ
85012-2368
US

IV. Provider business mailing address

PO BOX 5693
GOODYEAR AZ
85338-0612
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-2443
  • Fax: 602-274-7739
Mailing address:
  • Phone: 602-230-2443
  • Fax: 602-274-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberY005425
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: OLUFEMI OMODARA
Title or Position: RPH
Credential:
Phone: 602-230-2443