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NPI Code Detail

MEDICARE: COMMUNITY PHCY

MEDICARE: COMMUNITY PHCY
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 Pharmacy1918AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10300664OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568473130
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY PHCY
Provider Business Mailing Address
First Line : 7305 E VISAO DR
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85266-2707
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 17233 N HOLMES BLVD
Second Line : STE 1615
City : PHOENIX
State : AZ
Zip : 85053-2018
Country : US
Telephone Number : 602-993-2600
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JEFF GUBERNICK
Credential :
Telephone Number : 480-575-1103
Provider Enumeration Date : 08/10/2006
Last Update Date : 03/18/2008

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Directions to “COMMUNITY PHCY ” Practice Location

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