Healthcare Provider Details

I. General information

NPI: 1992127682
Provider Name (Legal Business Name): ACACIA APOTHECARY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 W ORANGE GROVE RD SUITE 115
TUCSON AZ
85704-1134
US

IV. Provider business mailing address

1845 W ORANGE GROVE RD STE 115
TUCSON AZ
85704-1146
US

V. Phone/Fax

Practice location:
  • Phone: 520-670-0777
  • Fax: 520-620-9738
Mailing address:
  • Phone: 520-670-0777
  • Fax: 520-488-2566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberY005818
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. SAGE SUFFECOOL
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D
Phone: 520-670-0777