| NPI | 1104238039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY CANONIC Senior Director, Enrollment 480-277-6348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: SD 100-1995) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2025-06-09 |