Provider Demographics
NPI:1710674668
Name:HEALTHCARE PHARMACY LLC
Entity Type:Organization
Organization Name:HEALTHCARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-704-0044
Mailing Address - Street 1:2320 W PEORIA AVE STE D132-A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4753
Mailing Address - Country:US
Mailing Address - Phone:602-704-0044
Mailing Address - Fax:602-767-5522
Practice Address - Street 1:2320 W PEORIA AVE STE D132-A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4753
Practice Address - Country:US
Practice Address - Phone:602-704-0044
Practice Address - Fax:602-767-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ155435Medicaid