Organization
PINE DRUGS
Active
Other names
PINE DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY ALLEN (OWNER)
(480) 251-6363
Entity
Organization
Contact information
Practice address
4010 N HIGHWAY 87, PINE, AZ 85544
(928) 476-3141
(928) 476-6513
Mailing address
PO BOX 1811, PINE, AZ 85544-1811
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4959
AZ
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0355239
OTHER ID NUMBER
—
Enumeration date
03/05/2008
Last updated
04/16/2008
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