Organization
MARYVALE PHARMACY INC
Active
Other names
M D PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD BATES BS CHE BSPHARM (OWNER)
(623) 846-1888
Entity
Organization
Contact information
Practice address
4700 N 51ST AVE STE 1, PHOENIX, AZ 85031-1237
(623) 846-1888
(623) 848-8202
Mailing address
4700 N 51ST AVE STE 1, PHOENIX, AZ 85031-1237
(623) 846-1888
(623) 848-8202
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y002881
AZ
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1997277
PK
—
05
—
380379
—
AZ
Enumeration date
08/10/2006
Last updated
06/08/2016
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