Organization
BANNER PHARMACY SERVICES LLC
Active
Organization
BANNER PHARMACY SERVICES LLC
Active
Other names
Banner Family Pharmacy-Univ. Med. Institute 1441
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL FUNK (CEO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
(602) 521-5000
(602) 521-5010
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
(602) 747-4000
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y006870
AZ
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178558
—
AZ
01
—
2160984
PK
—
Enumeration date
06/20/2016
Last updated
04/20/2026
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