Healthcare Provider Details

I. General information

NPI: 1518251909
Provider Name (Legal Business Name): AIRPARK PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15021 N 74TH ST STE 100
SCOTTSDALE AZ
85260-2497
US

IV. Provider business mailing address

15021 N 74TH ST SUITE 100
SCOTTSDALE AZ
85260-2497
US

V. Phone/Fax

Practice location:
  • Phone: 480-319-9749
  • Fax: 602-792-3825
Mailing address:
  • Phone: 480-319-9749
  • Fax: 602-792-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberY005338
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN DISCERNI
Title or Position: RPH-MEMBER
Credential:
Phone: 480-319-9749