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General NPI Number Information
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NPI Number | 1093820011
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Entity Type | Organization
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Legal Business Name | CAMELBACK VILLAGE PHARMACY INC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 4416 E CAMELBACK RD
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City | PHOENIX
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State | AZ
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Zip | 85018-2824
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Country | US
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Telephone | 602-955-2880
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Fax | 602-956-3784
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Provider Business Mailing Address
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Address Line | 4416 E CAMELBACK RD
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City | PHOENIX
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State | AZ
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Zip | 85018-2824
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Country | US
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Telephone | 602-840-1111
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Fax | 602-840-0111
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS MEYERS
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Credential |
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Telephone | 602-840-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | Y02307
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License Number State | AZ
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