Provider Demographics
NPI:1063419299
Name:UNIVERSITY OF ARIZONA COLLEGE OF PHARMACY
Entity type:Organization
Organization Name:UNIVERSITY OF ARIZONA COLLEGE OF PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:BOOTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-626-1657
Mailing Address - Street 1:PO BOX 210207
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0207
Mailing Address - Country:US
Mailing Address - Phone:520-626-1657
Mailing Address - Fax:520-626-4063
Practice Address - Street 1:1703 E MABEL ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0001
Practice Address - Country:US
Practice Address - Phone:520-626-1657
Practice Address - Fax:520-626-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17001835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty