MEDICARE: KRUSKAMD MURRILLO 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	3336C0003X	Community/Retail Pharmacy	Y02936	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0320313	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
3	0320313	OTHER	OTHER ID NUMBER

General Provider Information

NPI Number	:	1841369790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRUSKAMD MURRILLO INC

Provider Business Mailing Address
First Line	:	10810 E VIA LINDA
Second Line	:	STE 104
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-3909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 N 32ND ST
Second Line	:	STE 5
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3849
Country	:	US
Telephone Number	:	602-275-5719
Fax Number	:	602-392-0556

Authorized Official
Title or Position	:	PRES
Name	:	GREG ROLLER
Credential	:
Telephone Number	:	602-275-5719

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	02/19/2008

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Directions to “KRUSKAMD MURRILLO INC ” Practice Location

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