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General NPI Number Information
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NPI Number | 1952533556
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Entity Type | Organization
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Legal Business Name | SUN VALLEY PHARMACY LLC
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 219 W PIMA
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City | GILA BEND
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State | AZ
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Zip | 85353
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Country | US
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Telephone | 928-927-5300
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Fax | 928-927-5299
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Provider Business Mailing Address
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Address Line | PO BOX 4620
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City | QUARTZSITE
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State | AZ
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Zip | 85359-4620
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Country | US
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Telephone | 480-294-3391
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Fax | 928-927-5299
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Authorized Official
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Title or Position | MEMBER
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Name | HALIM HASSANI
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Credential | RPH
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Telephone | 928-927-5300
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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 | Y005169
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License Number State | AZ
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