Provider Demographics
NPI:1669547121
Name:PACEY, JOHN EDWARD (R PH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:PACEY
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E WALTANN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3507
Mailing Address - Country:US
Mailing Address - Phone:602-354-5922
Mailing Address - Fax:
Practice Address - Street 1:3141 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4351
Practice Address - Country:US
Practice Address - Phone:602-664-5494
Practice Address - Fax:602-664-5466
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-10561183500000X
NV10246183500000X
AZS016943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist