Provider Demographics
NPI:1093827073
Name:SANT DRUG INC
Entity Type:Organization
Organization Name:SANT DRUG INC
Other - Org Name:SANT UNITED DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:928-783-7856
Mailing Address - Street 1:419 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2957
Mailing Address - Country:US
Mailing Address - Phone:928-783-7856
Mailing Address - Fax:928-783-0842
Practice Address - Street 1:419 W 8TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2957
Practice Address - Country:US
Practice Address - Phone:928-783-7856
Practice Address - Fax:928-783-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
AZY0002003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031576Medicaid
1997301OtherPK
1997301OtherPK