Fairmont Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

Y005270 Issued in AZ

Legal business name

FAIRMONT PHARMACY, LLC

Practice address

5068 N Central Ave
Phoenix, AZ 85012-1521

Phone

(602) 319-1732

NPI assigned

Apr 23, 2010

Organization subpart

No

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

Authorized official

Name

Greg Roller

Title

Pharmacy Manager

Phone

(602) 319-1732

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fairmont Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mayur Dev, PHARM D

  • Pharmacist
  • Phoenix, AZ
  • NPI 1235835745
  NPD (past)

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

{
    "created_epoch": "1271980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271980800000",
    "number": "1184941585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5068 N CENTRAL AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5068 N CENTRAL AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121521",
            "telephone_number": "602-319-1732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRMONT PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-23",
        "last_updated": "2010-04-23",
        "status": "A",
        "authorized_official_last_name": "ROLLER",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "602-319-1732"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y005270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZSBP",
            "identifier": "Y005270",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairmont Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Fairbairn-Rodriguez
• Braiden Clark Fairbanks, PA-C
• Ronald T Faircloth, LPC, LISAC
• Fairclough Behavior Services LLC Az
• Rebecca Joanne Fairfax, OTR L
• Faith & Courage Psychiatry and Beyond LLC
• Faith and Comfort Home Care Services LLC
• Faith Behavioral Health Group, LLC
• Faith Care Solutions LLC
• Faith Home Health LLC

• Community/Retail Pharmacy in Phoenix, AZ
• Providers in Phoenix, 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 Apr 23, 2010; 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.