=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588589956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLAZE PHARMACY DBA VERRA RX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2026
-----------------------------------------------------
Last Update Date | 08/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 S IRONWOOD DR STE 104
-----------------------------------------------------
City | APACHE JUNCTION
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85120-6242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-595-9664
-----------------------------------------------------
Fax | 602-595-1376
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 850 S IRONWOOD DR STE 104
-----------------------------------------------------
City | APACHE JUNCTION
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85120-6242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-595-9664
-----------------------------------------------------
Fax | 602-595-1376
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MICHELLE WOOD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-274-3543
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------