Provider Demographics
NPI:1518251909
Name:AIRPARK PHARMACY, LLC
Entity Type:Organization
Organization Name:AIRPARK PHARMACY, LLC
Other - Org Name:AIRPARK PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DISCERNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-319-9749
Mailing Address - Street 1:15021 N 74TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2497
Mailing Address - Country:US
Mailing Address - Phone:480-319-9749
Mailing Address - Fax:602-792-3825
Practice Address - Street 1:15021 N 74TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2497
Practice Address - Country:US
Practice Address - Phone:480-319-9749
Practice Address - Fax:602-792-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0053383336C0004X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0357118OtherNCPDP PROVIDER IDENTIFICATION NUMBER