Healthcare Provider Details

I. General information

NPI: 1740648708
Provider Name (Legal Business Name): PHARMCARE USA OF GREATER PHOENIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 E BROADWAY RD
PHOENIX AZ
85040-8843
US

IV. Provider business mailing address

PO BOX 10
HYDRO OK
73048-0010
US

V. Phone/Fax

Practice location:
  • Phone: 602-438-9301
  • Fax: 855-937-0794
Mailing address:
  • Phone: 602-438-9301
  • Fax: 855-937-0794

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 TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberY006685
License Number StateAZ

VIII. Authorized Official

Name: BARNEY KENT ABBOTT
Title or Position: PRESIDENT
Credential:
Phone: 405-663-4111