Provider Demographics
NPI:1497099089
Name:PHARMCAREUSA OF PHOENIX, LLC
Entity Type:Organization
Organization Name:PHARMCAREUSA OF PHOENIX, LLC
Other - Org Name:PHARMCAREUSA OF PHOENIX, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-403-2003
Mailing Address - Street 1:4320 E BROWN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4082
Mailing Address - Country:US
Mailing Address - Phone:480-832-9008
Mailing Address - Fax:480-832-9008
Practice Address - Street 1:4320 E BROWN RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4081
Practice Address - Country:US
Practice Address - Phone:480-832-9008
Practice Address - Fax:480-832-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0055593336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0357752OtherNCPDP PROVIDER IDENTIFICATION NUMBER