Organization
THUMB BUTTE PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEDRAM PEZESHKI (PHARMACIST)
(818) 912-0132
Entity
Organization
Contact information
Practice address
3120 WILLOW CREEK RD # 150, PRESCOTT, AZ 86301-6610
(928) 237-4006
(928) 237-4008
Mailing address
1712 CLAIRE ST, PRESCOTT, AZ 86301-7446
(818) 912-0132
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y006909
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2175348
PK
—
05
—
356158
—
AZ
Enumeration date
07/03/2017
Last updated
06/07/2018
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