Organization
BANNER PHARMACY SERVICES LLC
Active
Organization
BANNER PHARMACY SERVICES LLC
Active
Other names
Banner Family Pharmacy - Desert
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL FUNK (CEO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1400 S DOBSON RD, MESA, AZ 85202-4707
(480) 412-4250
(480) 412-4252
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
(602) 747-4000
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y005805
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2145016
PK
—
05
—
896515
—
AZ
Enumeration date
12/16/2013
Last updated
04/15/2026
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