Active NPI
Banner Pharmacy Services LLC
- Community/Retail Pharmacy
- Glendale, AZ
National Provider Identifier
1417545534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- BANNER PHARMACY SERVICES LLC
- Practice address
- 7701 W Aspera Blvd Ste 103
Glendale, AZ 85308-7935 - Phone
- (623) 248-2000
- Fax
- (623) 707-4814
- NPI assigned
- Jan 5, 2021
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
7701 W Aspera Blvd Ste 103
Glendale, AZ 85308-7935
Mailing address
2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702
Phone (602) 747-4000
Other names 1
- Banner Family Pharmacy - New River Trails
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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.
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
7701 W Aspera Blvd
Ste 103
Glendale, AZ 85308
Phone (623) 248-2000
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609804800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1776297600000",
"number": "1417545534",
"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": "7701 W ASPERA BLVD STE 103",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853087935",
"telephone_number": "623-248-2000",
"fax_number": "623-707-4814"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BANNER PHARMACY SERVICES LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-01-05",
"last_updated": "2026-04-16",
"certification_date": "2026-04-16",
"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": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Banner Family Pharmacy - New River Trails",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Glendale, AZ
- Vicki Banks, M.A.
- Jennifer Bann
- Banner Family Pharmacy
- Banner Occupational Health Arizona LLC
- Banner Pharmacy Services LLC
- Banner Physician Specialists Arizona LLC
- Banner Physician Specialists Arizona LLC
- Banner Physician Specialists Arizona LLC
- Banner Physician Super Specialists Arizona LLC
- Banner Physician Super Specialists Arizona LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 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.