Provider Demographics
NPI:1578806394
Name:BIG PARK PHARMACY LLC
Entity Type:Organization
Organization Name:BIG PARK PHARMACY LLC
Other - Org Name:PRESCOTT COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUSER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:928-515-2354
Mailing Address - Street 1:1000 AINSWORTH DRIVE
Mailing Address - Street 2:SUITE B-105
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305
Mailing Address - Country:US
Mailing Address - Phone:928-515-2354
Mailing Address - Fax:928-515-2356
Practice Address - Street 1:1000 AINSWORTH DRIVE
Practice Address - Street 2:SUITE B-105
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305
Practice Address - Country:US
Practice Address - Phone:928-515-2354
Practice Address - Fax:928-515-2356
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIG PARK PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-29
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55503336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy