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NORTHERN ARIZONA PHARMACY LLC NPI 1194175588


NPI Information

NPI: 1194175588
Provider Name: NORTHERN ARIZONA PHARMACY LLC

Doing Business As: CHINO VALLEY PHARMACY

Classification: Pharmacy - 333600000X
Entity Type: Organization

CLIA Number: 03D2209291

Address:
1932 N STATE ROUTE 89
CHINO VALLEY, AZ
ZIP 86323
Phone: (928) 515-0046
Get Directions

NORTHERN ARIZONA PHARMACY LLC is a pharmacy in Chino Valley, AZ. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. NORTHERN ARIZONA PHARMACY LLC NPI is 1194175588. The provider is registered as an organization entity type.
The provider Is Doing Business As Chino Valley Pharmacy.

The provider's business location address is:

1932 N STATE ROUTE 89
CHINO VALLEY, AZ
ZIP 86323-643
Phone: (928) 515-0046
Fax: (928) 515-0047

The provider's authorized official is Jason James Dykstra .
The authorized official title is Pharmacist and has the following contact phone number (928) 515-0046.

The CLIA number assigned to this NPI record is 03D2209291 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/15/2016 and was last updated on 12/20/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1333600000XPharmacyY006900ARIZONAYes
23336C0003XPharmacyCommunity/Retail PharmacyNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1171606MEDICAIDARIZONA
22160678OTHERPK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.