Provider Demographics
NPI:1841369790
Name:KRUSKAMD MURRILLO INC
Entity type:Organization
Organization Name:KRUSKAMD MURRILLO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-275-5719
Mailing Address - Street 1:10810 E VIA LINDA
Mailing Address - Street 2:STE 104
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-3909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1617 N 32ND ST
Practice Address - Street 2:STE 5
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-3849
Practice Address - Country:US
Practice Address - Phone:602-275-5719
Practice Address - Fax:602-392-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY029363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031170Medicaid
0320313OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0320313OtherOTHER ID NUMBER