Healthcare Provider Details

I. General information

NPI: 1558415992
Provider Name (Legal Business Name): PORTABLE MEDICAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 E GRANT RD STE 388
TUCSON AZ
85712-5805
US

IV. Provider business mailing address

5538 DUNCAN DR
LAS VEGAS NV
89130-2812
US

V. Phone/Fax

Practice location:
  • Phone: 520-296-0317
  • Fax: 520-296-0417
Mailing address:
  • Phone: 702-939-6562
  • Fax: 702-939-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number4292
License Number StateAZ

VIII. Authorized Official

Name: JAMES TOOMEY
Title or Position: OWNER
Credential:
Phone: 702-491-6447