Healthcare Provider Details

I. General information

NPI: 1942942610
Provider Name (Legal Business Name): PINNACLE RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 W UNIVERSITY DR STE 113
TEMPE AZ
85281-3268
US

IV. Provider business mailing address

1625 W UNIVERSITY DR STE 113
TEMPE AZ
85281-3268
US

V. Phone/Fax

Practice location:
  • Phone: 602-653-7940
  • Fax:
Mailing address:
  • Phone: 602-653-7940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DANIEL CLARK
Title or Position: PARTNER
Credential:
Phone: 602-653-7940