Provider Demographics
NPI:1598887648
Name:BANNER DESERT OUTPATIENT PHARMACY
Entity type:Organization
Organization Name:BANNER DESERT OUTPATIENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LABBE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:480-512-5772
Mailing Address - Street 1:1400 S DOBSON RD
Mailing Address - Street 2:ATTN CARL LABBE RPH
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4707
Mailing Address - Country:US
Mailing Address - Phone:480-512-5772
Mailing Address - Fax:
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4768
Practice Address - Country:US
Practice Address - Phone:480-461-0490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BANNER HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-06
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy