Organization
REMGBEKOR
Active
Other names
SOUTH CENTRAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
OLUFEMI OMODARA (OWNER)
(602) 441-3564
Entity
Organization
Contact information
Practice address
7227 S CENTRAL AVE STE 1080, PHOENIX, AZ 85042-5457
(602) 441-3564
(602) 441-4838
Mailing address
PO BOX 5693, GOODYEAR, AZ 85338-0612
(602) 441-3564
(602) 441-4838
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y007459
AZ
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176046
PK
—
05
—
365183
—
AZ
Enumeration date
02/08/2018
Last updated
07/19/2018
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