Organization
ABUNDANT ENTERPRISES L.L.C
Active
Other names
grace rexall drugs
Organization subpart
No
Provider details
NPI number
Authorized official
OLUFEMI OMODARA (MANAGER)
(602) 277-5444
Entity
Organization
Contact information
Practice address
1102 W INDIAN SCHOOL RD, STE A, PHOENIX, AZ 85013-3107
(602) 277-5444
(602) 274-8821
Mailing address
PO BOX 5693, GOODYEAR, AZ 85338-0612
(602) 277-5444
(602) 274-8821
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y005374
AZ
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0357106
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/23/2011
Last updated
05/23/2011
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