Organization
EZYFAST PHARMACY L L C
Active
Other names
EzyFast Pharmacy L.L.C
Organization subpart
No
Provider details
NPI number
Authorized official
EZEKIEL KESITILWE (OWNER)
(928) 230-9812
Entity
Organization
Contact information
Practice address
2580 HIGHWAY 95 STE 106, BULLHEAD CITY, AZ 86442-7324
(928) 219-5912
(928) 219-5915
Mailing address
PO BOX 21238, BULLHEAD CITY, AZ 86439-1238
(928) 219-5912
(928) 219-5915
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y005478
AZ
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0357447
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
697715
—
AZ
Enumeration date
03/15/2012
Last updated
05/22/2012
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