MEDICARE: ALLERGYRX

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	3336C0004X	Compounding Pharmacy	Y006414	AZ

General Provider Information

NPI Number	:	1609251537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGYRX

Provider Business Mailing Address
First Line	:	3960 E PALM ST BLDG 5
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1118
Country	:	US
Telephone Number	:	480-339-2382
Fax Number	:	480-820-1833

Provider Business Practice Location Address
First Line	:	3960 E PALM ST BLDG 5
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1118
Country	:	US
Telephone Number	:	480-339-2382
Fax Number	:	480-820-1833

Authorized Official
Title or Position	:	PHARMACIST
Name	:	DANIEL DEE
Credential	:	PHARM.D
Telephone Number	:	480-299-5595

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	07/21/2015

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Directions to “ALLERGYRX ” Practice Location

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