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General NPI Number Information
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NPI Number | 1073069860
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Entity Type | Organization
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Legal Business Name | BGH PHARMACY
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 3544 W GLENDALE AVE STE E
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City | PHOENIX
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State | AZ
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Zip | 85051-8359
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Country | US
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Telephone | 623-455-3368
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Fax | 623-243-5314
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Provider Business Mailing Address
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Address Line | 3544 W GLENDALE AVE SUITE E
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City | PHOENIX
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State | AZ
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Zip | 85051-8359
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Country | US
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Telephone | 623-455-3368
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Fax | 623-243-5314
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Authorized Official
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Title or Position | PIC/OWENR
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Name | APRIL AL FATLAWI
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Credential |
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Telephone | 623-455-3368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | Y006953
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License Number State | AZ
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