Provider Demographics
NPI:1912499500
Name:AZ PHARMACY, LLC
Entity Type:Organization
Organization Name:AZ PHARMACY, LLC
Other - Org Name:AMAZON PHARMACY #002
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-745-5725
Mailing Address - Street 1:220 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1257
Mailing Address - Country:US
Mailing Address - Phone:855-745-5725
Mailing Address - Fax:623-289-9864
Practice Address - Street 1:3809 E WATKINS ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-7264
Practice Address - Country:US
Practice Address - Phone:855-745-5725
Practice Address - Fax:623-289-9864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0076323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177890OtherPK