Provider Demographics
NPI:1851607444
Name:1ST CARE PHARMACY LLC
Entity Type:Organization
Organization Name:1ST CARE PHARMACY LLC
Other - Org Name:1ST CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAMECK
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAKWEBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-932-9800
Mailing Address - Street 1:1300 S WATSON RD STE 104A
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-6264
Mailing Address - Country:US
Mailing Address - Phone:623-251-3201
Mailing Address - Fax:623-251-3205
Practice Address - Street 1:1300 S WATSON RD STE 104A
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-6264
Practice Address - Country:US
Practice Address - Phone:623-251-3201
Practice Address - Fax:623-251-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
AZY0052893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0356801OtherNCPDP PROVIDER IDENTIFICATION NUMBER