Provider Demographics
NPI:1659641694
Name:DIVERSIFIED PHARMACY SOLUTIONS LLC
Entity Type:Organization
Organization Name:DIVERSIFIED PHARMACY SOLUTIONS LLC
Other - Org Name:VISTOSO DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RHOADS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-271-7413
Mailing Address - Street 1:63717 E SADDLEBROOKE BLVD # 1
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-1258
Mailing Address - Country:US
Mailing Address - Phone:520-818-2883
Mailing Address - Fax:520-818-1833
Practice Address - Street 1:1171 E RANCHO VISTOSO BLVD
Practice Address - Street 2:SUITE 161
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-9107
Practice Address - Country:US
Practice Address - Phone:520-818-2883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0054623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0357346OtherNCPDP PROVIDER IDENTIFICATION NUMBER