Healthcare Provider Details

I. General information

NPI: 1467690966
Provider Name (Legal Business Name): MEDONE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 S INDUSTRIAL PARK AVE
TEMPE AZ
85282-1821
US

IV. Provider business mailing address

PO BOX 24757
TEMPE AZ
85285-4757
US

V. Phone/Fax

Practice location:
  • Phone: 480-835-9100
  • Fax: 480-729-6999
Mailing address:
  • Phone: 480-835-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberY004906
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: DIANE PAGLIUCA
Title or Position: VP
Credential:
Phone: 480-835-9100