Basic Information
| Provider Information | |||||||||
| NPI: | 1487399937 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DESERT SENITA ARIZONA CITY PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 N MALACATE ST | ||||||||
| Address2: | |||||||||
| City: | AJO | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853212254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203875651 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14574 S. SUNLAND GIN RD | ||||||||
| Address2: | |||||||||
| City: | ARIZONA CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203875651 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2022 | ||||||||
| LastUpdateDate: | 05/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | SANCHEZ | ||||||||
| AuthorizedOfficialFirstName: | MARINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | POPULATION HEALTH MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5203875651 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.