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General NPI Number Information
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NPI Number | 1396845343
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Entity Type | Organization
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Legal Business Name | STATE OF ARIZONA
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 1224 E LOWELL ST
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City | TUCSON
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State | AZ
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Zip | 85721-0095
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Country | US
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Telephone | 520-621-6516
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Fax | 520-626-8628
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Provider Business Mailing Address
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Address Line | 1224 E LOWELL ST
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City | TUCSON
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State | AZ
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Zip | 85721-0095
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Country | US
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Telephone | 520-621-6516
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Fax | 520-626-8628
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | KIM BIRMINGHAM
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Credential | RPH
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Telephone | 520-621-6516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 000501
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License Number State | AZ
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