MEDICARE: PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y008029	OTHER	AZ	STATE BOARD OF PHARMACY PERMIT

General Provider Information

NPI Number	:	1821554460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY LLC

Provider Business Mailing Address
First Line	:	10290 N 92ND ST STE 101
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4508
Country	:	US
Telephone Number	:	480-889-4392
Fax Number	:	480-687-2237

Provider Business Practice Location Address
First Line	:	10290 N 92ND ST STE 101
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4508
Country	:	US
Telephone Number	:	480-889-4392
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MS. ARMINE KOZAKYAN
Credential	:
Telephone Number	:	480-223-0833

Provider Enumeration Date	:	02/19/2019
Last Update Date	:	11/10/2020

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Directions to “PHARMACY LLC ” Practice Location

Language	Start Address	Practice Location

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