Healthcare Provider Details

I. General information

NPI: 1518642644
Provider Name (Legal Business Name): MESA NEIGHBORHOOD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E THOMAS RD STE 105
PHOENIX AZ
85016-7672
US

IV. Provider business mailing address

1701 E THOMAS RD STE 105
PHOENIX AZ
85016-7672
US

V. Phone/Fax

Practice location:
  • Phone: 602-237-6677
  • Fax:
Mailing address:
  • Phone: 602-237-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VITTELIAN FORBES
Title or Position: OWNER
Credential: PHARMD
Phone: 602-237-6677