Organization
ARIZONA COMMUNITY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YULIYA K ILYUSHENKO PHARMD (OWNER)
(323) 704-5369
Entity
Organization
Contact information
Practice address
14100 N 83RD AVE STE 160, PEORIA, AZ 85381
(623) 230-3194
(623) 233-1610
Mailing address
14100 N 83RD AVE STE 160, PEORIA, AZ 85381-5653
(623) 230-3194
(623) 233-1610
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Y007643
AZ
3336C0003X
Community/Retail Pharmacy
—
AZ
3336L0003X
Long Term Care Pharmacy
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431832
—
AZ
Enumeration date
04/04/2018
Last updated
01/14/2019
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