Provider Demographics
NPI:1124186952
Name:DIAMONDBACK DRUGS OF DELAWARE LLC
Entity Type:Organization
Organization Name:DIAMONDBACK DRUGS OF DELAWARE LLC
Other - Org Name:DIAMONDBACK DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:PANZARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF PHARM
Authorized Official - Phone:480-946-2223
Mailing Address - Street 1:7631 E INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3607
Mailing Address - Country:US
Mailing Address - Phone:480-946-2223
Mailing Address - Fax:480-946-2235
Practice Address - Street 1:7631 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3607
Practice Address - Country:US
Practice Address - Phone:480-946-2223
Practice Address - Fax:480-946-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANP000022333600000X, 333600000X
3336C0003X
AZY0061343336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146386OtherPK