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General NPI Number Information
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NPI Number | 1295887552
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Entity Type | Organization
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Legal Business Name | MIXTURES PHARMACY LLC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 16515 S 40TH ST STE 123
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City | PHOENIX
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State | AZ
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Zip | 85048-0559
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Country | US
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Telephone | 480-706-0620
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Fax | 480-706-0489
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Provider Business Mailing Address
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Address Line | 16515 S 40TH ST STE 123
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City | PHOENIX
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State | AZ
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Zip | 85048-0559
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Country | US
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Telephone | 480-706-0620
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Fax | 480-706-0489
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | LORI ALLEN
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Credential | RPH
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Telephone | 480-706-0620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | YO3896
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 3986
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 3896
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License Number State | AZ
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