1851615579 NPI number — EL RIO SANTA CRUZ NEIGHBORHOOD

Table of content: (NPI 1851615579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851615579 NPI number — EL RIO SANTA CRUZ NEIGHBORHOOD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL RIO SANTA CRUZ NEIGHBORHOOD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EL RIO PASCUA PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851615579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1231
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85702-1231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-670-3813
Provider Business Mailing Address Fax Number:
520-670-7560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7490 S CAMINO DE OESTE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85746-9308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-838-6617
Provider Business Practice Location Address Fax Number:
520-578-4059
Provider Enumeration Date:
03/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CARZOLI
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
520-309-3959

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: Y005258 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2124321 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0356584 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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