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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