| NPI | 1770791410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE ANN RIVERS Managed Care Plan Specialist 623-869-3524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |