Healthcare Provider Details

I. General information

NPI: 1407848468
Provider Name (Legal Business Name): CIGNA HEALTH CARE OF ARIZONA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 E BELL RD STE 2100
PHOENIX AZ
85032-2180
US

IV. Provider business mailing address

25500 N NORTERRA DR
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 602-404-5220
  • Fax: 602-404-5221
Mailing address:
  • Phone: 623-277-1168
  • Fax: 623-277-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1505
License Number StateAZ

VIII. Authorized Official

Name: CHARLES RYON
Title or Position: PHARMACY AREA MANAGER
Credential:
Phone: 623-277-1168