Provider Demographics
NPI:1376867218
Name:COMMUNITY DRUGSTORE VI LLC
Entity Type:Organization
Organization Name:COMMUNITY DRUGSTORE VI LLC
Other - Org Name:COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBERNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-468-6337
Mailing Address - Street 1:7701 E GRAY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6958
Mailing Address - Country:US
Mailing Address - Phone:602-468-6337
Mailing Address - Fax:
Practice Address - Street 1:9305 W THOMAS RD STE 185
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3361
Practice Address - Country:US
Practice Address - Phone:602-468-6337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0052593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy