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General NPI Number Information
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NPI Number | 1922848480
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Entity Type | Organization
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Legal Business Name | PRODUCE PHARMACY LLC
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 3060 N LITCHFIELD RD STE 120
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City | GOODYEAR
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State | AZ
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Zip | 85395-7807
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Country | US
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Telephone | 623-231-7972
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Fax | 480-550-7948
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Provider Business Mailing Address
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Address Line | 7600 N 16TH ST STE 100
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City | PHOENIX
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State | AZ
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Zip | 85020-4446
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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 | MANAGER
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Name | BRETT BANNISTER
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Credential |
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Telephone | 623-231-7972
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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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