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General NPI Number Information
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NPI Number | 1366447005
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Entity Type | Organization
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Legal Business Name | AVELLA OF PHOENIX II, INC.
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 5040 N 15TH AVE STE 102
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City | PHOENIX
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State | AZ
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Zip | 85015-3329
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Country | US
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Telephone | 602-277-3181
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Fax | 602-277-3418
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Provider Business Mailing Address
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Address Line | 1606 W WHISPERING WIND DR
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City | PHOENIX
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State | AZ
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Zip | 85085-0678
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Country | US
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Telephone | 623-434-1700
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Fax | 623-434-3676
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Authorized Official
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Title or Position | CEO
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Name | JOHN D MUSIL
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Credential |
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Telephone | 623-434-3657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty 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 | Y005091
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License Number State | AZ
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