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NPI Code Detail

MEDICARE: MD PHARMACY LLC

MEDICARE: MD PHARMACY 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
13336C0003XCommunity/Retail Pharmacy50519CA
23336C0003XCommunity/Retail Pharmacy55276CA

General Provider Information

NPI Number : 1164729828
Entity Type Code : Organization
Provider Name (Legal Business Name) : MD PHARMACY LLC
Provider Business Mailing Address
First Line : 17250 N. HARTFORD DR.
Second Line : SUITE 115
City : SCOTTSDALE
State : AZ
Zip : 85255
Country : US
Telephone Number : 844-436-7928
Fax Number : 909-949-6331
Provider Business Practice Location Address
First Line : 1601 MONTE VISTA AVE
Second Line : SUITE 130
City : CLAREMONT
State : CA
Zip : 91711-2962
Country : US
Telephone Number : 909-949-6337
Fax Number : 909-949-6331
Authorized Official
Title or Position : CEO
Name : MR. MARK BOESEN
Credential :
Telephone Number : 602-616-8831
Provider Enumeration Date : 02/16/2011
Last Update Date : 12/14/2016

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Directions to “MD PHARMACY LLC ” Practice Location

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