ZZ-SUN CITY CBOC PHARM (2491)    INSTITUTION (4)

Name Value
NAME ZZ-SUN CITY CBOC PHARM
STATE ARIZONA
STREET ADDR. 1 13985 W. GRAND AVENUE SUITE 101
CITY SUN CITY
ZIP 85374-3626
OFFICIAL VA NAME SUN CITY PHARMACY
INACTIVE FACILITY FLAG INACTIVE
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME SUN CITY VA CBOC PHARMACY
ST. ADDR. 1 (MAILING) 13985 W. GRAND AVENUE SUITE 101
CITY (MAILING) SUN CITY
STATE (MAILING) ARIZONA
ZIP (MAILING) 85374-3626
EFFECTIVE DATE/TIME
  • 2006-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1871551986
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE MOUNTAIN
COUNTRY USA
TIMEZONE EXCEPTION SST Only
AGENCY CODE VA
POINTER TO AGENCY VA
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1871551986