Healthcare Provider Details

I. General information

NPI: 1912366774
Provider Name (Legal Business Name): PHARMCARE USA OF GREATER PHOENIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 S ALVERNON WAY STE 202
TUCSON AZ
85711-5693
US

IV. Provider business mailing address

P.O. BOX 365
HYDRO OK
73048
US

V. Phone/Fax

Practice location:
  • Phone: 602-438-9301
  • Fax: 405-663-4114
Mailing address:
  • Phone: 405-663-4111
  • Fax: 405-663-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberY006690
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERICA CRESWELL
Title or Position: EXECUTIVE ADMINISTRATIVE ASST. TO P
Credential:
Phone: 405-204-9783