Provider Demographics
NPI:1619969680
Name:CIGNA HEALTH CARE OF ARIZONA INC
Entity Type:Organization
Organization Name:CIGNA HEALTH CARE OF ARIZONA INC
Other - Org Name:CIGNA MEDICAL GROUP PHARMACY - NORTH VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:RYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-277-1168
Mailing Address - Street 1:25500 N NORTERRA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8200
Mailing Address - Country:US
Mailing Address - Phone:623-277-1168
Mailing Address - Fax:623-277-1023
Practice Address - Street 1:710 W BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-3507
Practice Address - Country:US
Practice Address - Phone:602-588-3710
Practice Address - Fax:602-588-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZ26753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1989759OtherPK