Organization
SANTA TERESA PHARMACY LLC
Active
Other names
Santa Teresa Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RAJ SHAH (MEMBER)
(928) 328-1000
Entity
Organization
Contact information
Practice address
151 S OAK AVE STE 200, SAN LUIS, AZ 85336-0756
(928) 328-1000
(928) 328-1001
Mailing address
151 S OAK AVE STE 200, SAN LUIS, AZ 85336-0756
(928) 328-1000
(928) 328-1001
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0356786
NCPDP
—
01
—
2125859
PK
—
Enumeration date
07/22/2010
Last updated
11/16/2021
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