Provider Demographics
NPI:1700641073
Name:DESERT LIFE PHARMACY LLC
Entity Type:Organization
Organization Name:DESERT LIFE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:SPAETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-477-9776
Mailing Address - Street 1:63675 E SADDLEBROOKE BLVD STE S
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-1297
Mailing Address - Country:US
Mailing Address - Phone:520-477-9776
Mailing Address - Fax:
Practice Address - Street 1:63675 E SADDLEBROOKE BLVD STE S
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-1297
Practice Address - Country:US
Practice Address - Phone:520-477-9776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESERT LIFE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy