Basic Information
| Provider Information | |||||||||
| NPI: | 1952842239 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERITA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2002 N FORBES BLVD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857451418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207950111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2002 N FORBES BLVD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857451418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207950111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 03/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | BACZEWSKI | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | HENRY | ||||||||
| AuthorizedOfficialTitleorPosition: | PHARMACY MANAGER PIC | ||||||||
| AuthorizedOfficialTelephone: | 5207950111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336H0001X | S017204 | AZ | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
No ID Information.