Provider Demographics
NPI:1326093154
Name:ACORN USA INC
Entity Type:Organization
Organization Name:ACORN USA INC
Other - Org Name:SUNWEST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YURI
Authorized Official - Middle Name:
Authorized Official - Last Name:EIDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-595-3555
Mailing Address - Street 1:1300 N 12TH ST
Mailing Address - Street 2:STE 555
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2848
Mailing Address - Country:US
Mailing Address - Phone:602-595-3555
Mailing Address - Fax:602-595-3605
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:STE 555
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-595-3555
Practice Address - Fax:602-595-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
AZY0052633336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125042OtherPK
AZ123626Medicaid
AZ123626Medicaid