Provider Demographics
NPI:1689163925
Name:PHARMAPRODIA LLC
Entity Type:Organization
Organization Name:PHARMAPRODIA LLC
Other - Org Name:PHARMAPRODIA COMPOUNDING PHARMACY GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NKWENTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-432-5500
Mailing Address - Street 1:15331 W BELL RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4102
Mailing Address - Country:US
Mailing Address - Phone:623-404-1000
Mailing Address - Fax:623-256-6491
Practice Address - Street 1:15331 W BELL RD STE 122
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4103
Practice Address - Country:US
Practice Address - Phone:623-404-1000
Practice Address - Fax:623-256-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0073433336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177335OtherPK