Provider Demographics
NPI:1912366774
Name:PHARMCARE USA OF GREATER PHOENIX LLC
Entity Type:Organization
Organization Name:PHARMCARE USA OF GREATER PHOENIX LLC
Other - Org Name:PHARMCARE USA OF TUSCON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATIVE ASST. TO P
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-204-9783
Mailing Address - Street 1:P.O. BOX 365
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048
Mailing Address - Country:US
Mailing Address - Phone:405-663-4111
Mailing Address - Fax:405-663-4114
Practice Address - Street 1:1835 S ALVERNON WAY STE 202
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-5693
Practice Address - Country:US
Practice Address - Phone:602-438-9301
Practice Address - Fax:405-663-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY006690333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158171OtherPK