Organization
SONORAN PHARMACY GROUP INC
Active
Other names
WellCare LTC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BLAIR WHITNEY (GREFFIER)
(360) 543-7376
Entity
Organization
Contact information
Practice address
4101 WAGON TRAIL AVE, LAS VEGAS, NV 89118-4426
(702) 576-9545
(702) 946-0353
Mailing address
1313 E MAPLE ST, SUITE 210, BELLINGHAM, WA 98225-5708
(360) 685-4270
(360) 205-7504
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PH02771
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2152490
PK
—
Enumeration date
03/01/2012
Last updated
11/07/2016
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