Healthcare Provider Details

I. General information

NPI: 1851333637
Provider Name (Legal Business Name): RIO RICO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 W FRONTAGE RD STE A
RIO RICO AZ
85648-6203
US

IV. Provider business mailing address

PO BOX 4768
RIO RICO AZ
85648-4768
US

V. Phone/Fax

Practice location:
  • Phone: 520-761-3338
  • Fax: 520-761-3339
Mailing address:
  • Phone: 520-307-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY004369
License Number StateAZ

VIII. Authorized Official

Name: JOSEPH COIL
Title or Position: OWNER
Credential:
Phone: 520-307-1669