Organization
BANNER PHARMACY SERVICES LLC
Active
Other names
Banner Family Pharmacy-Skyline
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL FUNK (CEO, PHARMACY SERVICES)
(602) 747-4197
Entity
Organization
Contact information
Practice address
2555 E 13TH ST STE 125, SUITE 125, LOVELAND, CO 80537-5135
(970) 820-4300
(970) 820-4303
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
(602) 747-4000
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO.1680000113
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2152767
PK
—
Enumeration date
04/14/2016
Last updated
07/26/2023
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