Provider Demographics
NPI:1821554460
Name:PHARMACY LLC
Entity Type:Organization
Organization Name:PHARMACY LLC
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZAKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-223-0833
Mailing Address - Street 1:10290 N 92ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4508
Mailing Address - Country:US
Mailing Address - Phone:480-889-4392
Mailing Address - Fax:480-687-2237
Practice Address - Street 1:10290 N 92ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4508
Practice Address - Country:US
Practice Address - Phone:480-889-4392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZY008029OtherSTATE BOARD OF PHARMACY PERMIT