Provider Demographics
NPI:1851333637
Name:RIO RICO PHARMACY LLC
Entity Type:Organization
Organization Name:RIO RICO PHARMACY LLC
Other - Org Name:RIO RICO PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:COIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-307-1669
Mailing Address - Street 1:PO BOX 4768
Mailing Address - Street 2:
Mailing Address - City:RIO RICO
Mailing Address - State:AZ
Mailing Address - Zip Code:85648-4768
Mailing Address - Country:US
Mailing Address - Phone:520-307-1669
Mailing Address - Fax:
Practice Address - Street 1:1131 W FRONTAGE RD STE A
Practice Address - Street 2:
Practice Address - City:RIO RICO
Practice Address - State:AZ
Practice Address - Zip Code:85648-6203
Practice Address - Country:US
Practice Address - Phone:520-761-3338
Practice Address - Fax:520-761-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0043693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1991963OtherPK