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NPI Code Detail

MEDICARE: SMARTPRACTICE ALLERGEN BANK LLC

MEDICARE: SMARTPRACTICE ALLERGEN BANK LLC
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
1333600000XPharmacyY005653AZ

General Provider Information

NPI Number : 1962833830
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMARTPRACTICE ALLERGEN BANK LLC
Provider Business Mailing Address
First Line : 3400 E MCDOWELL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-3884
Country : US
Telephone Number : 602-225-0595
Fax Number : 602-225-0599
Provider Business Practice Location Address
First Line : 3400 E MCDOWELL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-3884
Country : US
Telephone Number : 602-225-0595
Fax Number : 602-225-0599
Authorized Official
Title or Position : PHARMACIST IN CHARGE
Name : CHRISTINE KAY COOPMAN
Credential : RPH
Telephone Number : 602-225-0595
Provider Enumeration Date : 12/03/2013
Last Update Date : 12/03/2013

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Directions to “SMARTPRACTICE ALLERGEN BANK LLC ” Practice Location

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