Provider Demographics
NPI:1639282999
Name:YAVAPAI REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:YAVAPAI REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HUFFAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:928-771-5520
Mailing Address - Street 1:1003 WILLOW CREEK RD
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1641
Mailing Address - Country:US
Mailing Address - Phone:928-771-5520
Mailing Address - Fax:928-771-5521
Practice Address - Street 1:1003 WILLOW CREEK RD
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1641
Practice Address - Country:US
Practice Address - Phone:928-771-5520
Practice Address - Fax:928-771-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101741333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy