MEDICARE: S AND J 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	332B00000X	Durable Medical Equipment & Medical Supplies	Y001871	AZ
3	3336C0003X	Community/Retail Pharmacy	001871	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	332800000X	OTHER	AZ	DME SUPPLIER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0314714	OTHER		OTHER ID NUMBER
4	0314714	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1447261078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S AND J PHARMACY INC

Provider Business Mailing Address
First Line	:	333 E VIRGINIA AVE
Second Line	:	STE 120
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1206
Country	:	US
Telephone Number	:	602-257-1196
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 E VIRGINIA AVE
Second Line	:	STE 120
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1206
Country	:	US
Telephone Number	:	602-257-1196
Fax Number	:	602-257-0511

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN GENRICH
Credential	:	DPH
Telephone Number	:	602-257-1196

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	04/29/2008

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Directions to “S AND J PHARMACY INC ” Practice Location

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