Provider Demographics
NPI:1285908798
Name:SONORAN PHARMACY GROUP INC
Entity type:Organization
Organization Name:SONORAN PHARMACY GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GREFFIER
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-543-7376
Mailing Address - Street 1:1313 E MAPLE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5708
Mailing Address - Country:US
Mailing Address - Phone:360-685-4270
Mailing Address - Fax:360-205-7504
Practice Address - Street 1:4101 WAGON TRAIL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4426
Practice Address - Country:US
Practice Address - Phone:702-576-9545
Practice Address - Fax:702-946-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NVPH027713336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152490OtherPK