Provider Demographics
NPI:1487951828
Name:ACORN USA INC
Entity type:Organization
Organization Name:ACORN USA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:YURI
Authorized Official - Middle Name:
Authorized Official - Last Name:EIDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-595-3555
Mailing Address - Street 1:1300 N 12TH ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2848
Mailing Address - Country:US
Mailing Address - Phone:602-595-3555
Mailing Address - Fax:602-595-3605
Practice Address - Street 1:1300 N 12TH ST STE 406
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-595-3555
Practice Address - Fax:602-595-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336S0011X
AZY0053443336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0356988OtherNCPDP PROVIDER IDENTIFICATION NUMBER