Healthcare Provider Details

I. General information

NPI: 1326084872
Provider Name (Legal Business Name): DIGNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W THOMAS RD STE 190
PHOENIX AZ
85013
US

IV. Provider business mailing address

SJHMC LOCKBOX ATTN: GEN ACCTING FILE 57431
LOS ANGELES CA
90074-8781
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3970
  • Fax: 602-406-7145
Mailing address:
  • Phone: 602-406-3970
  • Fax: 602-406-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY003472
License Number StateAZ

VIII. Authorized Official

Name: JEFFREY JACKSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 602-406-4618