Provider Demographics
NPI:1568655207
Name:S&G PHARMACY INC
Entity Type:Organization
Organization Name:S&G PHARMACY INC
Other - Org Name:ROSY'S FARMACIA LA ESPERANZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:602-331-5323
Mailing Address - Street 1:1111 E NORTHERN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4188
Mailing Address - Country:US
Mailing Address - Phone:602-331-5323
Mailing Address - Fax:602-331-2458
Practice Address - Street 1:1111 E NORTHERN AVE STE A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4188
Practice Address - Country:US
Practice Address - Phone:602-331-5323
Practice Address - Fax:602-331-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0047733336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992589OtherPK
AZ281441Medicaid