Organization
BANNER HEALTH
Active
Organization
BANNER HEALTH
Active
Other names
BANNER GOOD SAMARITAN OP CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
925 E MCDOWELL RD, PHOENIX, AZ 85006-2502
(602) 239-4792
(602) 239-6790
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
3146
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0354441
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/30/2006
Last updated
01/31/2022
Update your record
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