Healthcare Provider Details

I. General information

NPI: 1871700435
Provider Name (Legal Business Name): ANAZAOHEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 W ARBY AVE SUITE 102
LAS VEGAS NV
89118-4682
US

IV. Provider business mailing address

5710 HOOVER BLVD
TAMPA FL
33634-5339
US

V. Phone/Fax

Practice location:
  • Phone: 702-873-8455
  • Fax: 702-873-6845
Mailing address:
  • Phone: 800-995-4363
  • Fax: 800-985-4363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH01471
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH01471
License Number StateNV

VIII. Authorized Official

Name: MR. DOUGLAS BERKOFF
Title or Position: VP, CFO
Credential:
Phone: 800-995-4363