Provider Demographics
NPI:1073599114
Name:EL RIO WEST PHARMACY
Entity type:Organization
Organization Name:EL RIO WEST PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:G
Authorized Official - Last Name:KUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-601-0607
Mailing Address - Street 1:1230 S CHERRYBELL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713
Mailing Address - Country:US
Mailing Address - Phone:520-205-4997
Mailing Address - Fax:520-882-2777
Practice Address - Street 1:1230 S CHERRYBELL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713
Practice Address - Country:US
Practice Address - Phone:520-205-4997
Practice Address - Fax:520-882-2777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-20
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY04293333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ962854Medicaid