Provider Demographics
NPI:1649281213
Name:CIVIC CENTER PHARMACY, LLC
Entity type:Organization
Organization Name:CIVIC CENTER PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/SECRETARY/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-808-9838
Mailing Address - Street 1:7331 E OSBORN DR
Mailing Address - Street 2:#208
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6435
Mailing Address - Country:US
Mailing Address - Phone:480-945-9519
Mailing Address - Fax:480-278-7812
Practice Address - Street 1:7331 E OSBORN DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6435
Practice Address - Country:US
Practice Address - Phone:480-945-9519
Practice Address - Fax:480-275-7812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZY009666OtherSTATE BOARD OF PHARMACY LICENSE
1988982OtherPK