Provider Demographics
NPI:1972133825
Name:ST JOSEPH PHAR LLC
Entity Type:Organization
Organization Name:ST JOSEPH PHAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-274-1140
Mailing Address - Street 1:333 W THOMAS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4401
Mailing Address - Country:US
Mailing Address - Phone:602-274-1140
Mailing Address - Fax:602-274-1347
Practice Address - Street 1:333 W THOMAS RD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4401
Practice Address - Country:US
Practice Address - Phone:602-274-1140
Practice Address - Fax:602-274-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy