Provider Demographics
NPI:1386244861
Name:CANYONLANDS COMMUNITY HEALTHCARE
Entity type:Organization
Organization Name:CANYONLANDS COMMUNITY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARI
Authorized Official - Middle Name:A
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-645-9675
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:AZ
Mailing Address - Zip Code:85534-0708
Mailing Address - Country:US
Mailing Address - Phone:928-645-6620
Mailing Address - Fax:
Practice Address - Street 1:103 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:AZ
Practice Address - Zip Code:85534-8234
Practice Address - Country:US
Practice Address - Phone:928-645-9675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANYONLANDS COMMUNITY HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR000037OtherSTATE OF ARIZONA PHARMACY BOARD