Provider Demographics
NPI:1073709119
Name:AVE MARIA PHARMACY P.L.L.C.
Entity Type:Organization
Organization Name:AVE MARIA PHARMACY P.L.L.C.
Other - Org Name:AVE MARIA PHARMACY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:928-772-8674
Mailing Address - Street 1:1945 COMMERCE CENTER CIR
Mailing Address - Street 2:STE C
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-7411
Mailing Address - Country:US
Mailing Address - Phone:928-772-8674
Mailing Address - Fax:928-772-8413
Practice Address - Street 1:1945 COMMERCE CENTER CIR
Practice Address - Street 2:STE C
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-7411
Practice Address - Country:US
Practice Address - Phone:928-772-8674
Practice Address - Fax:928-772-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
AZY0048873336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992604OtherPK