Organization
JAREKO LLC
Active
Other names
FAVOR REXALL DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
OLUFEMI OMODARA RPH (PHARMACIST)
(602) 277-5444
Entity
Organization
Contact information
Practice address
4207 N 19TH AVE, PHOENIX, AZ 85015-5116
(602) 277-5444
(602) 274-8821
Mailing address
4207 N 19TH AVE, PHOENIX, AZ 85015-5116
(602) 277-5444
(602) 274-8821
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y004318
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0353285
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
977316
—
AZ
Enumeration date
01/04/2007
Last updated
08/29/2012
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