Provider Demographics
NPI:1467439091
Name:EL RIO HEALTH CENTER PHARMACY
Entity Type:Organization
Organization Name:EL RIO HEALTH CENTER PHARMACY
Other - Org Name:EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARZOLI
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:520-309-3959
Mailing Address - Street 1:839 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2819
Mailing Address - Country:US
Mailing Address - Phone:520-670-3724
Mailing Address - Fax:520-670-3842
Practice Address - Street 1:839 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2819
Practice Address - Country:US
Practice Address - Phone:520-670-3724
Practice Address - Fax:520-670-3842
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-23
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY00805333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ306341OtherAHCCCS ID NUMBER
AZ0306957OtherNCPDP
AZY00805OtherPHARMACY PERMIT