Organization
OLD PUEBLO DRUG
Active
Other names
OLD PUEBLO DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
MYRON GINSBURG (OWNER)
(520) 455-0058
Entity
Organization
Contact information
Practice address
3272 HWY 82, SONOITA, AZ 85637
(520) 455-0058
(502) 455-4782
Mailing address
PO BOX 508, SONOITA, AZ 85637-0508
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
YO2983
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1997300
PK
—
05
—
307787
—
AZ
Enumeration date
02/16/2007
Last updated
06/05/2015
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