Organization
STATE OF ARIZONA
Active
Other names
U OF COLLEGE OF PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BOESEN (DIR MEDICATION MNGMNT CNTR)
(520) 626-3981
Entity
Organization
Contact information
Practice address
1295 N MARTIN, TUCSON, AZ 85721-0001
(520) 626-3981
(520) 626-6026
Mailing address
PO BOX 210602, TUCSON, AZ 85721-0001
(520) 626-3981
(520) 626-6026
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
1700
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0314067
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/22/2006
Last updated
01/17/2012
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