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General NPI Number Information
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NPI Number | 1962833830
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Entity Type | Organization
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Legal Business Name | SMARTPRACTICE ALLERGEN BANK LLC
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 3400 E MCDOWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85008-3884
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Country | US
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Telephone | 602-225-0595
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Fax | 602-225-0599
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Provider Business Mailing Address
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Address Line | 3400 E MCDOWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85008-3884
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Country | US
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Telephone | 602-225-0595
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Fax | 602-225-0599
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | CHRISTINE KAY COOPMAN
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Credential | RPH
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Telephone | 602-225-0595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | Y005653
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License Number State | AZ
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