Provider Demographics
NPI:1386931616
Name:AVELLA OF PHOENIX II, INC
Entity type:Organization
Organization Name:AVELLA OF PHOENIX II, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MUSIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:623-434-3657
Mailing Address - Street 1:1606 W WHISPERING WIND DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-1322
Mailing Address - Country:US
Mailing Address - Phone:623-434-1700
Mailing Address - Fax:623-434-3673
Practice Address - Street 1:5040 N 15TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3329
Practice Address - Country:US
Practice Address - Phone:602-277-3181
Practice Address - Fax:602-277-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AZY0050913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies