Provider Demographics
NPI:1073843272
Name:ROADRUNNER PHARMACY, INC
Entity Type:Organization
Organization Name:ROADRUNNER PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:623-434-1180
Mailing Address - Street 1:711 E CAREFREE HWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-0101
Mailing Address - Country:US
Mailing Address - Phone:623-434-1180
Mailing Address - Fax:623-434-1181
Practice Address - Street 1:711 E CAREFREE HWY
Practice Address - Street 2:SUITE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-0101
Practice Address - Country:US
Practice Address - Phone:623-434-1180
Practice Address - Fax:623-434-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy