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General NPI Number Information
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NPI Number | 1558619023
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Entity Type | Organization
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Legal Business Name | BASELINE PHARMACY
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 303 E BASELINE RD STE 103
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City | PHOENIX
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State | AZ
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Zip | 85042-6561
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Country | US
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Telephone | 602-903-7228
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Fax |
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Provider Business Mailing Address
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Address Line | 303 E BASELINE RD STE 103
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City | PHOENIX
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State | AZ
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Zip | 85042-6561
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Country | US
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Telephone | 602-903-7228
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Fax |
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Authorized Official
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Title or Position | PIC
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Name | DR. VILAWOE A. BOADU
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Credential | PHARMD
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Telephone | 602-903-7228
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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 | Y005528
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License Number State | AZ
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