Organization
CASA GRANDE PHARMACY INC
Active
Other names
Grand Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMED ESLAM ELMISSIREY RPH (OFFICER,PIC,AO)
(480) 444-6612
Entity
Organization
Contact information
Practice address
1659 E FLORENCE BLVD STE 7, CASA GRANDE, AZ 85122-4785
(520) 518-5720
(480) 371-2757
Mailing address
1659 E FLORENCE BLVD STE 7, CASA GRANDE, AZ 85122-4785
(520) 518-5720
(480) 371-2757
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y006618
AZ
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
083433
—
AZ
01
—
2155127
PK
—
Enumeration date
11/10/2015
Last updated
02/11/2016
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