Organization
STATE OF ARIZONA
Active
Other names
ARIZONA STATE HOSPITAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY HOLLADAY PHARMD (DOP)
(602) 220-6060
Entity
Organization
Contact information
Practice address
2500 E VAN BUREN ST, PHOENIX, AZ 85008-6037
(602) 220-6060
(602) 220-6194
Mailing address
2500 E VAN BUREN ST, PHOENIX, AZ 85008-6037
(602) 220-6060
(602) 220-6194
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
Y000486
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1988000
PK
—
Enumeration date
08/10/2006
Last updated
07/19/2018
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