Provider Demographics
NPI:1629296322
Name:CARESITE PHARMACY OF ARIZONA LLC
Entity type:Organization
Organization Name:CARESITE PHARMACY OF ARIZONA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MESSINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-7285
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:MC 24-15
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-2415
Mailing Address - Country:US
Mailing Address - Phone:570-271-7965
Mailing Address - Fax:
Practice Address - Street 1:10238 E. HAMPTON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208
Practice Address - Country:US
Practice Address - Phone:480-986-2681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ234472OtherAHCCCS
AZ234472OtherAHCCCS