Provider Demographics
NPI:1598721136
Name:DM ESTRELLA PHARMACY INC
Entity Type:Organization
Organization Name:DM ESTRELLA PHARMACY INC
Other - Org Name:ESTRELLA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEMBABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-388-5025
Mailing Address - Street 1:9305 W THOMAS RD
Mailing Address - Street 2:STE 185
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3328
Mailing Address - Country:US
Mailing Address - Phone:623-388-5025
Mailing Address - Fax:623-388-5075
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:STE 185
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:623-388-5025
Practice Address - Fax:623-388-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-22
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0056373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ127688Medicaid
2140131OtherPK