Provider Demographics
NPI:1407386410
Name:MIXTURES PHARMACY, LLC SCOTTSDALE
Entity Type:Organization
Organization Name:MIXTURES PHARMACY, LLC SCOTTSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:480-706-0620
Mailing Address - Street 1:16515 S 40TH ST STE 123
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0559
Mailing Address - Country:US
Mailing Address - Phone:480-706-0620
Mailing Address - Fax:480-706-0489
Practice Address - Street 1:6590 N SCOTTSDALE RD STE 140
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4482
Practice Address - Country:US
Practice Address - Phone:480-400-0649
Practice Address - Fax:480-418-6649
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIXTURES PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0072513336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZY007251OtherARIZONA PHARMACY LICENSE