Healthcare Provider Details

I. General information

NPI: 1457164535
Provider Name (Legal Business Name): BELL ROAD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W BELL RD STE 1A
PHOENIX AZ
85053-2748
US

IV. Provider business mailing address

4025 W BELL RD STE 1A
PHOENIX AZ
85053-2748
US

V. Phone/Fax

Practice location:
  • Phone: 602-439-3366
  • Fax: 602-795-7734
Mailing address:
  • Phone: 602-439-3366
  • Fax: 602-795-7734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LIDIA TERESA DICKINSON
Title or Position: OWNER
Credential:
Phone: 602-705-1136