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General NPI Number Information
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NPI Number | 1467958611
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Entity Type | Organization
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Legal Business Name | ARIZONA COMMUNITY PHARMACY
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 01/14/2019
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Provider Practice Location Address
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Address Line | 14100 N 83RD AVE STE 160
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City | PEORIA
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State | AZ
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Zip | 85381
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Country | US
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Telephone | 623-230-3194
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Fax | 623-233-1610
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Provider Business Mailing Address
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Address Line | 14100 N 83RD AVE STE 160
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City | PEORIA
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State | AZ
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Zip | 85381-5653
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Country | US
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Telephone | 623-230-3194
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Fax | 623-233-1610
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Authorized Official
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Title or Position | OWNER
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Name | YULIYA K ILYUSHENKO
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Credential | PHARMD
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Telephone | 323-704-5369
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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 | Y007643
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License Number State | AZ
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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 |
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State | AZ
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