=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568407880
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2006
-----------------------------------------------------
Last Update Date | 10/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 E VAN BUREN ST
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85323-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-344-6823
-----------------------------------------------------
Fax | 623-344-6806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 E VAN BUREN ST
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85323-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-344-6823
-----------------------------------------------------
Fax | 623-344-6806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | ANNA SOGARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-344-5253
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | Y004179
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------