Healthcare Provider Details

I. General information

NPI: 1639282999
Provider Name (Legal Business Name): YAVAPAI REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 WILLOW CREEK RD OUTPATIENT PHARMACY
PRESCOTT AZ
86301-1641
US

IV. Provider business mailing address

1003 WILLOW CREEK RD OUTPATIENT PHARMACY
PRESCOTT AZ
86301-1641
US

V. Phone/Fax

Practice location:
  • Phone: 928-771-5520
  • Fax: 928-771-5521
Mailing address:
  • Phone: 928-771-5520
  • Fax: 928-771-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number101741
License Number StateAZ

VIII. Authorized Official

Name: MR. GREGORY JOHN HUFFAKER
Title or Position: OUTPATIENT PHARMACY MANAGER
Credential: RPH
Phone: 928-771-5520