MEDICARE: DIVERSIFIED PHARMACY SOLUTIONS

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	3336C0003X	Community/Retail Pharmacy	Y005104	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1988477	OTHER	PK

General Provider Information

NPI Number	:	1841249471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSIFIED PHARMACY SOLUTIONS

Provider Business Mailing Address
First Line	:	63717 E SADDLEBROOKE BLVD # 1
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85739-1258
Country	:	US
Telephone Number	:	520-818-3804
Fax Number	:	520-818-0464

Provider Business Practice Location Address
First Line	:	63717 E SADDLEBROOKE BLVD # 1
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85739-1258
Country	:	US
Telephone Number	:	520-818-3804
Fax Number	:	520-818-0464

Authorized Official
Title or Position	:	OWNER
Name	:	JOEL RHOADS
Credential	:
Telephone Number	:	520-271-7413

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	02/27/2014

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Directions to “DIVERSIFIED PHARMACY SOLUTIONS ” Practice Location

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