Old Pueblo Drug

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

YO2983 Issued in AZ

Legal business name

OLD PUEBLO DRUG

Doing business as

Old Pueblo Drug

Practice address

3272 Hwy 82
Sonoita, AZ 85637

Phone

(520) 455-0058

Fax

(502) 455-4782

NPI assigned

Feb 16, 2007

Last updated

Jun 5, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Myron Ginsburg

Title

Owner

Phone

(520) 455-0058

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• OLD PUEBLO DRUG Doing business as

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433462400000",
    "number": "1093859795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 508",
            "city": "SONOITA",
            "state": "AZ",
            "postal_code": "856370508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3272 HWY 82",
            "city": "SONOITA",
            "state": "AZ",
            "postal_code": "85637",
            "telephone_number": "520-455-0058",
            "fax_number": "502-455-4782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD PUEBLO DRUG",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2015-06-05",
        "status": "A",
        "authorized_official_last_name": "GINSBURG",
        "authorized_official_first_name": "MYRON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-455-0058"
    },
    "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": "YO2983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1997300",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "307787",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OLD PUEBLO DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Sonoita, AZ
• Providers in Sonoita, AZ by specialty
• Community/Retail Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; 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.