Provider Demographics
NPI:1912312315
Name:EAST VALLEY PATIENT CARE SERVICES
Entity type:Organization
Organization Name:EAST VALLEY PATIENT CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:PIC
Authorized Official - Phone:623-466-0117
Mailing Address - Street 1:2501 W BEHREND DR
Mailing Address - Street 2:SUITE #69
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4146
Mailing Address - Country:US
Mailing Address - Phone:623-466-0117
Mailing Address - Fax:623-266-3592
Practice Address - Street 1:218 W HAMPTON AVE
Practice Address - Street 2:#4
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5231
Practice Address - Country:US
Practice Address - Phone:480-448-6407
Practice Address - Fax:480-223-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0057153336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy