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General NPI Number Information
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NPI Number | 1649334442
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY HEALTHCARE, INC.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2920 NORTH 4TH STREET
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City | FLAGSTAFF
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State | AZ
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Zip | 86004
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Country | US
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Telephone | 928-213-0589
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Fax | 928-213-0597
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Provider Business Mailing Address
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Address Line | 2920 NORTH 4TH STREET
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City | FLAGSTAFF
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State | AZ
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Zip | 86004
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Country | US
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Telephone | 928-213-0589
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Fax | 928-213-0597
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Authorized Official
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Title or Position | CEO
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Name | ANN M ROGGENBUCK
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Credential |
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Telephone | 928-774-8325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 3287
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License Number State | AZ
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