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NPI Code Detail

MEDICARE: CIGNA HEALTHCAREOF AZ, INC.

MEDICARE: CIGNA HEALTHCAREOF AZ, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy0326428AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10326428OTHERAZNABP NUMBER

General Provider Information

NPI Number : 1053521245
Entity Type Code : Organization
Provider Name (Legal Business Name) : CIGNA HEALTHCAREOF AZ, INC.
Provider Business Mailing Address
First Line : 25500 N NORTERRA DR
Second Line : ATTN: PHARMACY ADMINISTRATION
City : PHOENIX
State : AZ
Zip : 85085-8200
Country : US
Telephone Number : 623-277-1168
Fax Number : 623-277-1023
Provider Business Practice Location Address
First Line : 9014 N 23RD AVE
Second Line : SUITE 14 & 15
City : PHOENIX
State : AZ
Zip : 85021-2853
Country : US
Telephone Number : 602-216-6630
Fax Number : 602-216-6631
Authorized Official
Title or Position : PHARMACY AREA MANAGER
Name : SARJU PATEL
Credential : R.PH.
Telephone Number : 623-277-1168
Provider Enumeration Date : 05/23/2007
Last Update Date : 10/14/2011

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