Healthcare Provider Details

I. General information

NPI: 1487951828
Provider Name (Legal Business Name): ACORN USA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 12TH ST STE 406
PHOENIX AZ
85006-2848
US

IV. Provider business mailing address

1300 N 12TH ST SUITE 406
PHOENIX AZ
85006-2848
US

V. Phone/Fax

Practice location:
  • Phone: 602-595-3555
  • Fax: 602-595-3605
Mailing address:
  • Phone: 602-595-3555
  • Fax: 602-595-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberY005344
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: YURI EIDELMAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 602-595-3555