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General NPI Number Information
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NPI Number | 1407292816
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Entity Type | Organization
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Legal Business Name | MOHAVE PHARMACY L.L.C.
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Dates
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Enumeration Date | 05/13/2013
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 5225 S HIGHWAY 95 STE 9
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-9111
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Country | US
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Telephone | 928-768-3356
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Fax |
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Provider Business Mailing Address
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Address Line | 5225 S HIGHWAY 95 STE 9
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-9111
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. ERNST M KRUGER
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Credential |
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Telephone | 928-234-5522
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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 | Y005643
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License Number State | AZ
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