Provider Demographics
NPI:1326837741
Name:MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
Entity type:Organization
Organization Name:MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-506-6665
Mailing Address - Street 1:1645 E ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3638
Mailing Address - Country:US
Mailing Address - Phone:602-506-6665
Mailing Address - Fax:602-506-5078
Practice Address - Street 1:5141 W LAMAR RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-3423
Practice Address - Country:US
Practice Address - Phone:602-506-6665
Practice Address - Fax:602-506-5078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARICOPA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy