Organization
NORTHERN ARIZONA PHARMACY LLC
Active
Other names
Dewey Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON JAMES DYKSTRA PHARMD (MANAGER)
(928) 515-0046
Entity
Organization
Contact information
Practice address
12075 E STATE ROUTE 69, SUITE E, DEWEY, AZ 86327
(928) 515-0455
(928) 515-0456
Mailing address
1932 N STATE ROUTE 89, CHINO VALLEY, AZ 86323-5643
(928) 515-0046
(928) 515-0047
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003672
—
AZ
Enumeration date
12/26/2019
Last updated
12/08/2020
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