Provider Demographics
NPI:1346566015
Name:NEIGHBORHOOD PHARMACY LLC
Entity Type:Organization
Organization Name:NEIGHBORHOOD PHARMACY LLC
Other - Org Name:NEIGHBORHOOD PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLOI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:480-507-3393
Mailing Address - Street 1:2571 S VAL VISTA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6232
Mailing Address - Country:US
Mailing Address - Phone:480-507-3393
Mailing Address - Fax:480-507-3998
Practice Address - Street 1:2571 S VAL VISTA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6232
Practice Address - Country:US
Practice Address - Phone:480-507-3393
Practice Address - Fax:480-507-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0052503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ517094Medicaid
0356647OtherNCPDP PROVIDER IDENTIFICATION NUMBER