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Organization

STATE OF ARIZONA

Active
Other names
BLACK CANYON SCHOOL PHARMACY
Organization subpart
No

Provider details

NPI number
Authorized official
RONALD WILLIAMS (MEDICAL DIRECTOR)
(602) 520-1663
Entity
Organization

Contact information

Practice address
24601 N 29TH AVE, PHOENIX, AZ 85083-1165
(623) 780-1303
(623) 879-7026
Mailing address
24601 N 29TH AVE, PHOENIX, AZ 85083-1165
(623) 780-1303
(623) 879-7026

Taxonomy

Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
Y01936
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1988966
PK
Enumeration date
10/24/2007
Last updated
04/12/2016
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