Healthcare Provider Details

I. General information

NPI: 1912499500
Provider Name (Legal Business Name): AZ PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 E WATKINS ST
PHOENIX AZ
85034-7264
US

IV. Provider business mailing address

220 INDUSTRIAL BLVD STE 100
AUSTIN TX
78745-1276
US

V. Phone/Fax

Practice location:
  • Phone: 855-745-5725
  • Fax: 623-289-9864
Mailing address:
  • Phone: 855-745-5725
  • Fax: 603-935-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY007632
License Number StateAZ

VIII. Authorized Official

Name: TANVI JAYANTI PATEL
Title or Position: VICE PRESIDENT
Credential:
Phone: 855-745-5725