Provider Demographics
NPI:1881732287
Name:KACHINA PHARMACY
Entity type:Organization
Organization Name:KACHINA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-726-4081
Mailing Address - Street 1:2180 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6478
Mailing Address - Country:US
Mailing Address - Phone:928-726-4081
Mailing Address - Fax:928-726-4127
Practice Address - Street 1:2180 S 4TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6478
Practice Address - Country:US
Practice Address - Phone:928-726-4081
Practice Address - Fax:928-726-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0325628OtherNCPDP
AZ552382Medicare UPIN