Provider Demographics
NPI:1962577544
Name:FOOTHILLS PROFESSIONAL PHARMACY LTD
Entity type:Organization
Organization Name:FOOTHILLS PROFESSIONAL PHARMACY LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PUJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-496-4444
Mailing Address - Street 1:2727 W BASELINE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1068
Mailing Address - Country:US
Mailing Address - Phone:480-496-4444
Mailing Address - Fax:480-496-4450
Practice Address - Street 1:2727 W BASELINE RD STE 1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1068
Practice Address - Country:US
Practice Address - Phone:480-496-4444
Practice Address - Fax:480-496-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 333600000X, 3336C0004X, 3336H0001X
AZY0075003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1991928OtherPK
AZ959885Medicaid
1991928OtherPK