NPIMap

Organization Active NPI

Banner Pharmacy Services LLC

Doing business as Banner Family Pharmacy - Desert

  • Community/Retail Pharmacy
  • Mesa, AZ
National Provider Identifier
1083035117
Registry record updated Apr 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y005805 Issued in AZ
Legal business name
BANNER PHARMACY SERVICES LLC
Doing business as
Banner Family Pharmacy - Desert
Practice address
1400 S Dobson Rd
Mesa, AZ 85202-4707
Phone
(480) 412-4250
Fax
(480) 412-4252
NPI assigned
Dec 16, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2026

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

Authorized official

Name
Russell Funk
Title
Ceo
Phone
(602) 747-4000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Y005805 AZ Primary

Addresses

Primary practice location

1400 S Dobson Rd
Mesa, AZ 85202-4707

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702
Phone (602) 747-4000

Other identifiers 2

IdentifierTypeStateIssuer
896515MedicaidAZ
2145016OtherPK

Other names 1

  • Banner Family Pharmacy - Desert Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140610000246 AZ Part B Supplier - Mass Immunization (Roster Biller Only) 9830322114 15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Casa Grande, AZ; Tucson, AZ; Sun City West, AZ; Sun City, AZ; Phoenix, AZ; Mesa, AZ; Gilbert, AZ; Glendale, AZ

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Banner Pharmacy Services LLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1387152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776211200000",
    "number": "1083035117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702",
            "telephone_number": "602-747-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S DOBSON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024707",
            "telephone_number": "480-412-4250",
            "fax_number": "480-412-4252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER PHARMACY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-16",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "status": "A",
        "authorized_official_last_name": "FUNK",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y005805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "896515",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2145016",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Banner Family Pharmacy - Desert",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Banner Family Pharmacy - Desert",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.