Provider Demographics
NPI:1477650075
Name:MARANA HEALTH CENTER
Entity type:Organization
Organization Name:MARANA HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:REDDING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:520-682-1095
Mailing Address - Street 1:13644 N SANDARIO RD
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-8579
Mailing Address - Country:US
Mailing Address - Phone:520-682-1095
Mailing Address - Fax:520-682-2196
Practice Address - Street 1:13644 N SANDARIO RD
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-8579
Practice Address - Country:US
Practice Address - Phone:520-682-1095
Practice Address - Fax:520-682-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4075302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization