Healthcare Provider Details

I. General information

NPI: 1558847954
Provider Name (Legal Business Name): M2D PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21321 E OCOTILLO RD # B104
QUEEN CREEK AZ
85142-5996
US

IV. Provider business mailing address

21321 E OCOTILLO RD # B104
QUEEN CREEK AZ
85142-5996
US

V. Phone/Fax

Practice location:
  • Phone: 480-534-1797
  • Fax: 480-534-1799
Mailing address:
  • Phone: 480-534-1797
  • Fax: 480-534-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY00764
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberY00764
License Number StateAZ

VIII. Authorized Official

Name: DAWN HOANG
Title or Position: MEMBER
Credential:
Phone: 480-534-1797