Provider Demographics
NPI:1497747455
Name:CIGNA HEALTH CARE OF ARIZONA INC
Entity Type:Organization
Organization Name:CIGNA HEALTH CARE OF ARIZONA INC
Other - Org Name:CIGNA MEDICAL GROUP PHARMACY - PASEO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY AREA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:RYON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:623-277-1168
Mailing Address - Street 1:25500 N NORTERRA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8200
Mailing Address - Country:US
Mailing Address - Phone:623-277-1168
Mailing Address - Fax:623-277-1023
Practice Address - Street 1:5891 W EUGIE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1252
Practice Address - Country:US
Practice Address - Phone:602-588-6808
Practice Address - Fax:602-588-6809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1504333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1988147OtherPK