Provider Demographics
NPI:1386700847
Name:SHAYONA PHARMACY INC
Entity type:Organization
Organization Name:SHAYONA PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LLAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:SR CPHT
Authorized Official - Phone:520-298-8449
Mailing Address - Street 1:310 N WILMOT RD
Mailing Address - Street 2:STE 310
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2618
Mailing Address - Country:US
Mailing Address - Phone:520-298-8449
Mailing Address - Fax:520-298-6150
Practice Address - Street 1:310 N WILMOT RD
Practice Address - Street 2:STE 310
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2618
Practice Address - Country:US
Practice Address - Phone:520-298-8449
Practice Address - Fax:520-298-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0046613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0327002OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AZ722042Medicaid
0327002OtherNCPDP PROVIDER IDENTIFICATION NUMBER