Provider Demographics
NPI:1962817437
Name:MAYO PHARMACY SCOTTSDALE IV
Entity Type:Organization
Organization Name:MAYO PHARMACY SCOTTSDALE IV
Other - Org Name:MAYO PHARMACY SCOTTSDALE IV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPV-PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-301-7650
Mailing Address - Street 1:13400 E SHEA BLVD
Mailing Address - Street 2:3RD FLOOR - ROOM # 306E
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5452
Mailing Address - Country:US
Mailing Address - Phone:480-301-7650
Mailing Address - Fax:480-301-9008
Practice Address - Street 1:13400 E SHEA BLVD
Practice Address - Street 2:3RD FLOOR - ROOM # 306E
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5452
Practice Address - Country:US
Practice Address - Phone:480-301-7650
Practice Address - Fax:480-301-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0028573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146432OtherPK