Healthcare Provider Details

I. General information

NPI: 1952775298
Provider Name (Legal Business Name): DIGNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N 6TH ST
PHOENIX AZ
85004-2155
US

IV. Provider business mailing address

625 N 6TH ST
PHOENIX AZ
85004-2155
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-0350
  • Fax: 602-406-0673
Mailing address:
  • Phone: 602-406-0350
  • Fax: 602-406-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY006423
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK LEACH
Title or Position: DIRECTOR OF PHARMACY/AO
Credential:
Phone: 602-406-0353