Organization
MIND 247 PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AISHA LYNN DEPRIEST (DIRECTOR OF CREDENTIALING)
(844) 646-3247
Entity
Organization
Contact information
Practice address
10046 N METRO PKWY W STE 115, PHOENIX, AZ 85051-1411
(844) 646-3247
(480) 546-4048
Mailing address
1465 N SCOTTSDALE RD STE 400, SCOTTSDALE, AZ 85257-3634
(844) 646-3247
(480) 546-4048
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Enumeration date
11/08/2022
Last updated
11/08/2022
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