Provider Demographics
NPI:1962833830
Name:SMARTPRACTICE ALLERGEN BANK LLC
Entity type:Organization
Organization Name:SMARTPRACTICE ALLERGEN BANK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:COOPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:602-225-0595
Mailing Address - Street 1:3400 E MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-3884
Mailing Address - Country:US
Mailing Address - Phone:602-225-0595
Mailing Address - Fax:602-225-0599
Practice Address - Street 1:3400 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-3884
Practice Address - Country:US
Practice Address - Phone:602-225-0595
Practice Address - Fax:602-225-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY005653333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy