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General NPI Number Information
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NPI Number | 1467898312
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Entity Type | Organization
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Legal Business Name | BROADWAY FAMILY PHARMACY PLLC
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 6006 S CENTRAL AVE
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City | PHOENIX
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State | AZ
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Zip | 85042-4235
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Country | US
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Telephone | 602-276-5485
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Fax | 602-276-0485
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Provider Business Mailing Address
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Address Line | 16538 W CENTRAL ST
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City | SURPRISE
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State | AZ
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Zip | 85388-1183
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Country | US
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Telephone | 602-384-0301
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Fax | 602-276-0485
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE, OWNER
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Name | OBINNA AKUBUKWE
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Credential | PHARM D
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Telephone | 602-384-0301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | Y005639
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License Number State | AZ
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