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General NPI Number Information
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NPI Number | 1669777348
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Entity Type | Organization
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Legal Business Name | EAGLE PHARMACY, LLC
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 16222 N 59TH AVE SUITE D175
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City | GLENDALE
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State | AZ
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Zip | 85306-1701
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Country | US
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Telephone | 602-354-5261
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Fax |
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Provider Business Mailing Address
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Address Line | 9869 W QUAIL TRACK DR
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City | PEORIA
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State | AZ
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Zip | 85383-8793
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Country | US
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Telephone | 602-312-8290
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. BRYAN KRUEGER
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Credential | RPH
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Telephone | 602-312-8290
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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 | Y005337
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License Number State | AZ
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