Organization
NORTHERN ARIZONA PHARMACY LLC
Active
Organization
NORTHERN ARIZONA PHARMACY LLC
Active
Other names
Cordes Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JASON JAMES DYKSTRA PHARMD (MANAGER)
(928) 515-0046
Entity
Organization
Contact information
Practice address
20172 E STAGECOACH TRL STE A, CORDES LAKES, AZ 86333-2357
(928) 968-5040
(928) 968-5041
Mailing address
1932 N STATE ROUTE 89, CHINO VALLEY, AZ 86323-5643
(928) 515-0046
(928) 515-0047
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y008474
ARIZONA STATE BOARD OF PHARMACY
AZ
Enumeration date
01/10/2021
Last updated
01/10/2021
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