Provider Demographics
NPI:1740380781
Name:LOBOS ACQUISITION OF ARIZONA, INC.
Entity Type:Organization
Organization Name:LOBOS ACQUISITION OF ARIZONA, INC.
Other - Org Name:DANNY'S RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:REGIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-347-9281
Mailing Address - Street 1:100 E RIVERCENTER BLVD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-1555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:520-795-8979
Practice Address - Street 1:5395 E ERICKSON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2826
Practice Address - Country:US
Practice Address - Phone:520-795-4271
Practice Address - Fax:520-795-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ821612Medicaid
0305549OtherNCPDP