Organization
NORTHERN ARIZONA PHARMACY LLC
Active
Other names
Chino Valley Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON JAMES DYKSTRA PHARMD (PHARMACIST)
(928) 515-0046
Entity
Organization
Contact information
Practice address
1932 N STATE ROUTE 89, CHINO VALLEY, AZ 86323-5643
(928) 515-0046
(928) 515-0047
Mailing address
1932 N STATE ROUTE 89, CHINO VALLEY, AZ 86323-5643
(928) 515-0046
(928) 515-0047
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
Y006900
AZ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171606
—
AZ
01
—
2160678
PK
—
Enumeration date
06/15/2016
Last updated
12/20/2019
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