NPIMap

Organization Active NPI

Phat Dai Tai LLC

Doing business as Xpress Care Pharmacy

  • Community/Retail Pharmacy
  • Phoenix, AZ
National Provider Identifier
1053616581
Registry record updated Jan 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y005332 Issued in AZ
Legal business name
PHAT DAI TAI LLC
Doing business as
Xpress Care Pharmacy
Practice address
2222 E Highland Ave Ste 102
Phoenix, AZ 85016-4874
Phone
(623) 535-5822
Fax
(623) 535-9711
NPI assigned
Jan 13, 2011
Last updated
Jan 13, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jackie PhanNPI 1043193394
Title
Owner
Phone
(623) 826-7748

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X Y005332 AZ Primary

Addresses

Primary practice location

2222 E Highland Ave Ste 102
Phoenix, AZ 85016-4874

Mailing address

13203 W Palo Verde Dr
Litchfield Park, AZ 85340-8356
Phone (623) 826-7748

Other identifiers 1

IdentifierTypeStateIssuer
0356938OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Xpress Care Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Phat Dai Tai LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294876800000",
    "number": "1053616581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13203 W PALO VERDE DR",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853408356",
            "telephone_number": "623-826-7748",
            "fax_number": "623-535-9711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 E HIGHLAND AVE STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164874",
            "telephone_number": "623-535-5822",
            "fax_number": "623-535-9711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHAT DAI TAI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-13",
        "last_updated": "2011-01-13",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-826-7748"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y005332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0356938",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Xpress Care Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.