Provider Demographics
NPI:1669784476
Name:ARIZONA PHARMACY LLC
Entity type:Organization
Organization Name:ARIZONA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMOUN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:SR
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:623-451-5154
Mailing Address - Street 1:20118 N 67TH AVE
Mailing Address - Street 2:SUITE 300-181
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4621
Mailing Address - Country:US
Mailing Address - Phone:623-451-5451
Mailing Address - Fax:623-398-7952
Practice Address - Street 1:13991 W GRAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3065
Practice Address - Country:US
Practice Address - Phone:623-451-5451
Practice Address - Fax:623-398-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0052763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy