RELIANCE SPECIALTY INFUSION, LLC - NPI NUMBER 1417208679

Summary

Provider Name: RELIANCE SPECIALTY INFUSION, LLC

NPI Number: 1417208679

Clasification: Pharmacy (3336S0011X)

Specialization: Specialty Pharmacy

Address:
2920 E MOHAWK LN
SUITE 114
PHOENIX, AZ
ZIP 85050

Phone Number: (602) 821-8218



Detailed Information

RELIANCE SPECIALTY INFUSION, LLC is a specialty pharmacy pharmacy in Phoenix, AZ. The provider is a pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration. The assigned NPI number for this provider is 1417208679 and is registered as an organization entity type.

The provider's business address is:

2920 E MOHAWK LN
SUITE 114
PHOENIX, AZ
ZIP 85050-772
Phone: (602) 821-8218

The provider's authorized official is Laura Gravina .
The authorized official title is Ceo and has the following contact phone number (602) 821-8218.

The enumeration date for this NPI number is 9/27/2012 and was last updated on 9/27/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 3336S0011X Pharmacy Specialty Pharmacy Y005540 AZ Yes

NPI Record

No. Field Name Field Value
1 NPI 1417208679
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name RELIANCE SPECIALTY INFUSION, LLC
5 Provider First Line Business Practice Location Address 2920 E MOHAWK LN
6 Provider Second Line Business Practice Location Address SUITE 114
7 Provider Business Practice Location Address City Name PHOENIX
8 Provider Business Practice Location Address State Name AZ
9 Provider Business Practice Location Address Postal Code 850504772
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 6028218218
12 Provider Enumeration Date 9/27/2012
13 Last Update Date 9/27/2012
14 Authorized Official Last Name GRAVINA
15 Authorized Official First Name LAURA
16 Authorized Official Title or Position CEO
17 Authorized Official Telephone Number 6028218218
18 Healthcare Provider Taxonomy Code 1 3336S0011X
19 Provider License Number 1 Y005540
20 Provider License Number State Code 1 AZ
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N
23 Authorized Official Name Prefix Text MISS
24 Authorized Official Credential Text CEO

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This page was last updated on: 9/11/2014
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.