MEDICARE: HOLISTIC HEALTHCARE LLC

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	Y005773	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2142772	OTHER		PK

General Provider Information

NPI Number	:	1154759603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	3361 W GREENWAY RD
Second Line	:	STE.2
City	:	PHOENIX
State	:	AZ
Zip	:	85053-7641
Country	:	US
Telephone Number	:	602-993-0766
Fax Number	:	602-993-0768

Provider Business Practice Location Address
First Line	:	3361 W GREENWAY RD
Second Line	:	STE.2
City	:	PHOENIX
State	:	AZ
Zip	:	85053-7641
Country	:	US
Telephone Number	:	602-993-0766
Fax Number	:	602-993-0768

Authorized Official
Title or Position	:	MANAGER, PIC
Name	:	BABATUNDE GHANNI
Credential	:	PHARM D
Telephone Number	:	602-993-0766

Provider Enumeration Date	:	10/18/2013
Last Update Date	:	04/06/2017

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Directions to “HOLISTIC HEALTHCARE LLC ” Practice Location

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