Organization
KRUSKAMD MURRILLO INC
Active
Other names
FAIRMONT UNITED DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
GREG ROLLER (PRES)
(602) 275-5719
Entity
Organization
Contact information
Practice address
1617 N 32ND ST, STE 5, PHOENIX, AZ 85008-3849
(602) 275-5719
(602) 392-0556
Mailing address
10810 E VIA LINDA, STE 104, SCOTTSDALE, AZ 85259-3909
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
Y02936
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031170
—
AZ
01
—
0320313
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/07/2006
Last updated
02/19/2008
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