Organization
PAYSON APOTHECARY PHARMACY LLC
Active
Other names
PAYSON APOTHECARY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG MATHEWS (OWNER)
(928) 468-8299
Entity
Organization
Contact information
Practice address
201 W MAIN ST, SUITE D, PAYSON, AZ 85541-5441
(928) 468-8299
(928) 468-8322
Mailing address
201 W MAIN ST, SUITE D, PAYSON, AZ 85541-5441
(928) 468-8299
(928) 468-8322
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y004258
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0326137
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
946014
—
AZ
Enumeration date
08/10/2006
Last updated
12/13/2012
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