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General NPI Number Information
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NPI Number | 1225201932
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Entity Type | Organization
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Legal Business Name | MEDCO AT HOME LLC
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Dates
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Enumeration Date | 04/03/2008
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 14811 N KIERLAND BLVD STE 100 RM 109
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-2729
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Country | US
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Telephone | 480-368-5005
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Fax | 480-368-5040
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Provider Business Mailing Address
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Address Line | 14811 N KIERLAND BLVD STE 100 RM 109
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-2729
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Country | US
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Telephone | 480-368-5005
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Fax | 480-368-5040
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Authorized Official
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Title or Position | SENIORDIRECTOR, LICENSING
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Name | LISA CANNONE
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Credential |
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Telephone | 314-684-5075
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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 | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | Y004924
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License Number State | AZ
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