Healthcare Provider Details

I. General information

NPI: 1477477388
Provider Name (Legal Business Name): CANYON RIVER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 W UNIVERSITY DR STE 103
TEMPE AZ
85281-3390
US

IV. Provider business mailing address

1328 W UNIVERSITY DR STE 103
TEMPE AZ
85281-3390
US

V. Phone/Fax

Practice location:
  • Phone: 480-977-6622
  • Fax: 877-708-1001
Mailing address:
  • Phone: 480-977-6622
  • Fax: 877-708-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AKSHAR PATEL
Title or Position: SOLE DIRECTOR
Credential:
Phone: 480-977-6622