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Contact Information

NORTHERN ARIZONA PHARMACY LLC
12075 E STATE ROUTE 69
SUITE E
DEWEY-HUMBOLDT, AZ86327
 Phone: 928-515-0455
 Fax: 928-515-0456
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for NORTHERN ARIZONA PHARMACY LLC

NPI # 1902445802
LBN Legal business name NORTHERN ARIZONA PHARMACY LLC
Authorized official JASON DYKSTRA - (MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 12/26/2019
Last updated 12/08/2020 - About 5 years ago
Identifiers
AZ Medicaid 003672
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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