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General NPI Number Information
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NPI Number | 1881732287
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Entity Type | Organization
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Legal Business Name | KACHINA PHARMACY
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 2180 S 4TH AVE SUITE B
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City | YUMA
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State | AZ
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Zip | 85364-6478
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Country | US
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Telephone | 928-726-4081
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Fax | 928-726-4127
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Provider Business Mailing Address
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Address Line | 2180 S 4TH AVE
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City | YUMA
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State | AZ
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Zip | 85364-6478
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Country | US
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Telephone | 928-726-4081
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Fax | 928-726-4127
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Authorized Official
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Title or Position | OWNER
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Name | DAVID PLATT
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Credential |
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Telephone | 928-726-4081
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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 | 3333
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License Number State | AZ
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