MEDICARE: ADEPA PHARMACY PLLC

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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1336749860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADEPA PHARMACY PLLC

Provider Business Mailing Address
First Line	:	8770 N THORNYDALE RD STE 190
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-9096
Country	:	US
Telephone Number	:	520-370-9770
Fax Number	:	520-244-1677

Provider Business Practice Location Address
First Line	:	8770 N THORNYDALE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-9096
Country	:	US
Telephone Number	:	480-310-9394
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	IRENE OWUSU-BOADI
Credential	:	PHARM.D
Telephone Number	:	520-370-9770

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	01/06/2021

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