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General NPI Number Information
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NPI Number | 1578996823
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Entity Type | Organization
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Legal Business Name | BANNER FAMILY PHARMACY
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Dates
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Enumeration Date | 08/09/2013
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 5555 W THUNDERBIRD RD
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City | GLENDALE
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State | AZ
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Zip | 85306-4622
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Country | US
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Telephone | 602-865-2378
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 N 12T ST
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City | PHOENIX
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State | AZ
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Zip | 85006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SR. VP FINANCE
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Name | DENNIS DAHLEN
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Credential |
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Telephone | 602-747-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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