Organization
ONTHEGO PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES ALLEN ROE (PHARMACY MANAGER/DELEGATED OFFICIAL)
(602) 607-5094
Entity
Organization
Contact information
Practice address
15830 N 35TH AVE, PHOENIX, AZ 85053-7640
(602) 607-5094
(602) 926-2370
Mailing address
15830 N 35TH AVE STE 3, PHOENIX, AZ 85053-7640
(026) 075-0946
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
589383
—
AZ
Enumeration date
05/30/2019
Last updated
02/04/2020
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