1467439091 NPI number — EL RIO HEALTH CENTER PHARMACY

Table of content: (NPI 1467439091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467439091 NPI number — EL RIO HEALTH CENTER PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL RIO HEALTH CENTER PHARMACY
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 SANTA CRUZ NEIGHBORHOOD HEALTH CENTER
Provider Other Organization Name Type Code:
4
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:
1467439091
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:
839 W CONGRESS ST
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:
85745-2819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-670-3724
Provider Business Mailing Address Fax Number:
520-670-3842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
839 W CONGRESS ST
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:
85745-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-670-3724
Provider Business Practice Location Address Fax Number:
520-670-3842
Provider Enumeration Date:
12/23/2005

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 , with the licence number:  Y00805 , 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: 306341 . This is a "AHCCCS ID NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0306957 . This is a "NCPDP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Y00805 . This is a "PHARMACY PERMIT" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com