NPIMap

Organization Active NPI

Ezyfast Pharmacy L L C

  • Community/Retail Pharmacy
  • Bullhead City, AZ
National Provider Identifier
1366717860
Registry record updated May 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y005478 Issued in AZ
Legal business name
EZYFAST PHARMACY L L C
Practice address
2580 Highway 95 Ste 106
Bullhead City, AZ 86442-7324
Phone
(928) 219-5912
Fax
(928) 219-5915
NPI assigned
Mar 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2012

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

Authorized official

Name
Ezekiel KesitilweNPI 1871001248
Title
Owner
Phone
(928) 230-9812

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Y005478 AZ Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

2580 Highway 95 Ste 106
Bullhead City, AZ 86442-7324

Mailing address

PO Box 21238
Bullhead City, AZ 86439-1238
Phone (928) 219-5912

Other identifiers 2

IdentifierTypeStateIssuer
697715MedicaidAZ
0357447OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • EzyFast Pharmacy L.L.C Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ezyfast Pharmacy2 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.

NPI Registry JSON

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

{
    "created_epoch": "1331769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337644800000",
    "number": "1366717860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21238",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864391238",
            "telephone_number": "928-219-5912",
            "fax_number": "928-219-5915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2580 HIGHWAY 95 STE 106",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864427324",
            "telephone_number": "928-219-5912",
            "fax_number": "928-219-5915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EZYFAST PHARMACY L L C",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-15",
        "last_updated": "2012-05-22",
        "status": "A",
        "authorized_official_last_name": "KESITILWE",
        "authorized_official_first_name": "EZEKIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-230-9812"
    },
    "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": "Y005478",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "697715",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0357447",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EzyFast Pharmacy L.L.C",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bullhead City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; 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.