Provider Demographics
NPI:1528202215
Name:FIRST ROYAL CARE CO LLC
Entity Type:Organization
Organization Name:FIRST ROYAL CARE CO LLC
Other - Org Name:RED MOUNTAIN COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-204-1442
Mailing Address - Street 1:6828 E BROWN RD
Mailing Address - Street 2:STE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-3761
Mailing Address - Country:US
Mailing Address - Phone:480-218-2236
Mailing Address - Fax:480-471-6005
Practice Address - Street 1:6828 E BROWN RD
Practice Address - Street 2:STE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3761
Practice Address - Country:US
Practice Address - Phone:480-218-2236
Practice Address - Fax:480-471-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0060793336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120042OtherPK