Provider Demographics
NPI:1235437914
Name:HSP INC
Entity Type:Organization
Organization Name:HSP INC
Other - Org Name:PRESCOTT VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMISSIREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-444-6612
Mailing Address - Street 1:3050 N WINDSONG DR
Mailing Address - Street 2:STE 103
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2265
Mailing Address - Country:US
Mailing Address - Phone:928-350-1500
Mailing Address - Fax:928-350-1504
Practice Address - Street 1:3050 N WINDSONG DR
Practice Address - Street 2:STE 103
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2265
Practice Address - Country:US
Practice Address - Phone:928-350-1500
Practice Address - Fax:928-350-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0053643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0357031OtherNCPDP PROVIDER IDENTIFICATION NUMBER