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NPI Code Detail

MEDICARE: BANNER HOME CARE-ARIZONA

MEDICARE: BANNER HOME CARE-ARIZONA
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
1332BP3500XParenteral & Enteral Nutrition Supplies (DME)
2333600000XPharmacy
33336C0004XCompounding Pharmacy
43336H0001XHome Infusion Therapy Pharmacy
5251F00000XHome Infusion Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972701332
Entity Type Code : Organization
Provider Name (Legal Business Name) : BANNER HOME CARE-ARIZONA
Provider Business Mailing Address
First Line : PO BOX 29325
Second Line :
City : PHOENIX
State : AZ
Zip : 85038-9325
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 525 W BROWN RD STE 1350
Second Line :
City : MESA
State : AZ
Zip : 85201-3202
Country : US
Telephone Number : 480-657-1000
Fax Number :
Authorized Official
Title or Position : CEO
Name : RUSSELL FUNK
Credential : PHARMD
Telephone Number : 602-747-4000
Provider Enumeration Date : 07/06/2007
Last Update Date : 07/08/2024

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Directions to “BANNER HOME CARE-ARIZONA ” Practice Location

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