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General NPI Number Information
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NPI Number | 1487244323
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Entity Type | Organization
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Legal Business Name | PALOVERDE HEALTH SERVICES PHARMACY LLC
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 18 W CENTER ST
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City | PIMA
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State | AZ
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Zip | 85543-0030
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Country | US
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Telephone | 928-322-6009
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | PIMA
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State | AZ
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Zip | 85543-0009
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Country | US
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Telephone | 928-485-4315
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Fax |
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Authorized Official
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Title or Position | OWNER/PIC
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Name | BRIAN EDWARD PAULL
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Credential |
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Telephone | 928-485-4315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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