Healthcare Provider Details

I. General information

NPI: 1750327847
Provider Name (Legal Business Name): TERRITORIAL DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 E ALLEN STREET
TOMBSTONE AZ
85638
US

IV. Provider business mailing address

PO BOX 1279
TOMBSTONE AZ
85638-1279
US

V. Phone/Fax

Practice location:
  • Phone: 520-457-3543
  • Fax: 520-457-3187
Mailing address:
  • Phone: 520-457-3543
  • Fax: 520-457-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY005508
License Number StateAZ

VIII. Authorized Official

Name: ANTHONY ROETHER
Title or Position: MANAGER
Credential: PHARMD
Phone: 520-457-3543