1598887648 NPI number — BANNER DESERT OUTPATIENT PHARMACY

Table of content: PAULA ELAINE SAIS RN (NPI 1881778447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598887648 NPI number — BANNER DESERT OUTPATIENT PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BANNER DESERT OUTPATIENT 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:
Provider Other Organization Name Type Code:
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:
1598887648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 S DOBSON RD
Provider Second Line Business Mailing Address:
ATTN CARL LABBE RPH
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85202-4707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-512-5772
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1432 S DOBSON RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85202-4768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-461-0490
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LABBE
Authorized Official First Name:
CARL
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
480-512-5772

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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