MEDICARE: CAMELBACK VILLAGE PHARMACY 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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	Y02307	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0313825	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093820011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMELBACK VILLAGE PHARMACY INC

Provider Business Mailing Address
First Line	:	4416 E CAMELBACK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2824
Country	:	US
Telephone Number	:	602-840-1111
Fax Number	:	602-840-0111

Provider Business Practice Location Address
First Line	:	4416 E CAMELBACK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2824
Country	:	US
Telephone Number	:	602-955-2880
Fax Number	:	602-956-3784

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENNIS MEYERS
Credential	:
Telephone Number	:	602-840-1111

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	05/17/2016

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Directions to “CAMELBACK VILLAGE PHARMACY INC ” Practice Location

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