Organization
FAIRMONT PHARMACY, LLC
Active
Organization
FAIRMONT PHARMACY, LLC
Active
Other names
Fairmont Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GREG ROLLER (PHARMACY MANAGER)
(602) 319-1732
Entity
Organization
Contact information
Practice address
5068 N CENTRAL AVE, PHOENIX, AZ 85012-1521
(602) 319-1732
Mailing address
5068 N CENTRAL AVE, PHOENIX, AZ 85012-1521
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
Y005270
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y005270
AZSBP
—
Enumeration date
04/23/2010
Last updated
04/23/2010
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