MEDICARE: ACACIA APOTHECARY AND WELLNESS 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
1	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy	Y005818	AZ

General Provider Information

NPI Number	:	1992127682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACACIA APOTHECARY AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	1845 W ORANGE GROVE RD STE 115
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1146
Country	:	US
Telephone Number	:	520-670-0777
Fax Number	:	520-488-2566

Provider Business Practice Location Address
First Line	:	1845 W ORANGE GROVE RD
Second Line	:	SUITE 115
City	:	TUCSON
State	:	AZ
Zip	:	85704-1134
Country	:	US
Telephone Number	:	520-670-0777
Fax Number	:	520-620-9738

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	DR. SAGE SUFFECOOL
Credential	:	PHARM D
Telephone Number	:	520-670-0777

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/21/2026

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