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General NPI Number Information
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NPI Number | 1932830205
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Entity Type | Organization
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Legal Business Name | NORTHERN ARIZONA PHARMACY
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Dates
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Enumeration Date | 06/18/2022
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Last Update Date | 06/18/2022
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Provider Practice Location Address
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Address Line | 12075 E STATE ROUTE 69 STE E
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City | DEWEY
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State | AZ
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Zip | 86327-4569
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Country | US
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Telephone | 928-515-0455
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Fax | 928-515-0456
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Provider Business Mailing Address
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Address Line | 1932 N STATE ROUTE 89
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City | CHINO VALLEY
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State | AZ
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Zip | 86323-5643
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Country | US
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Telephone | 928-515-0046
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Fax | 928-515-0047
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Authorized Official
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Title or Position | MANAGER
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Name | JASON JAMES DYKSTRA
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Credential | PHARMD
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Telephone | 928-515-0046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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