Healthcare Provider Details

I. General information

NPI: 1932869807
Provider Name (Legal Business Name): ANTHONY RAUL MEJIA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W VALENCIA RD
TUCSON AZ
85746-6021
US

IV. Provider business mailing address

4649 W CALLE DON TOMAS
TUCSON AZ
85757-9448
US

V. Phone/Fax

Practice location:
  • Phone: 520-573-3167
  • Fax:
Mailing address:
  • Phone: 520-704-4528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS025633
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: