Provider Demographics
NPI:1457669566
Name:KIERNAN APOTHECARIES PLLC
Entity Type:Organization
Organization Name:KIERNAN APOTHECARIES PLLC
Other - Org Name:MOUNTAIN VIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:480-948-7065
Mailing Address - Street 1:10565 N TATUM BLVD
Mailing Address - Street 2:B 118
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1095
Mailing Address - Country:US
Mailing Address - Phone:480-948-7065
Mailing Address - Fax:480-948-9489
Practice Address - Street 1:10565 N TATUM BLVD
Practice Address - Street 2:B 118
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1095
Practice Address - Country:US
Practice Address - Phone:480-948-7065
Practice Address - Fax:480-948-9489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
AZY0059483336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148377OtherPK