Provider Demographics
NPI:1073006557
Name:MARY & JOSEPH FOOD AND DRUG COMPANY, LLC
Entity type:Organization
Organization Name:MARY & JOSEPH FOOD AND DRUG COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:YOUKHANA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:602-675-0887
Mailing Address - Street 1:10210 N 32ND ST STE C7
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3826
Mailing Address - Country:US
Mailing Address - Phone:602-675-0887
Mailing Address - Fax:602-610-5844
Practice Address - Street 1:10210 N 32ND ST STE C7
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3826
Practice Address - Country:US
Practice Address - Phone:602-675-0887
Practice Address - Fax:602-610-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY007596332800000X
333600000X, 3336C0002X, 3336S0011X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2178043OtherPK