Provider Demographics
NPI:1104807296
Name:ARIZONA SENIOR CARE PHARMACY INC
Entity type:Organization
Organization Name:ARIZONA SENIOR CARE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER PRES
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:602-438-9301
Mailing Address - Street 1:PO BOX 8156
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-8156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2727 W BASELINE RD
Practice Address - Street 2:STE 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1067
Practice Address - Country:US
Practice Address - Phone:602-438-9301
Practice Address - Fax:602-438-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY036213336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1991388OtherPK
AZ708810Medicaid
1991388OtherPK