Active NPI
Northern Arizona Pharmacy LLC
Doing business as Cordes Pharmacy
- Community/Retail Pharmacy
- Cordes Lakes, AZ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- NORTHERN ARIZONA PHARMACY LLC
- Doing business as
- Cordes Pharmacy
- Practice address
- 20172 E Stagecoach TRL Ste a
Cordes Lakes, AZ 86333-2357 - Phone
- (928) 968-5040
- Fax
- (928) 968-5041
- NPI assigned
- Jan 10, 2021
- Last updated
- Jan 10, 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
- Jason James Dykstra, PHARMD
- Title
- Manager
- Phone
- (928) 515-0046
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | NU | Primary |
Addresses
Primary practice location
20172 E Stagecoach TRL Ste a
Cordes Lakes, AZ 86333-2357
Mailing address
1932 N State Route 89
Chino Valley, AZ 86323-5643
Phone (928) 515-0046
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y008474 | Other | AZ | ARIZONA STATE BOARD OF PHARMACY |
Other names 1
- Cordes Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170727002043 | AZ | Part B Supplier - Mass Immunization (Roster Biller Only) | 9234409939 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chino Valley, AZ; Dewey, AZ; Mayer, AZ |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Chino Valley Pharmacy
- Pharmacy
- Chino Valley, AZ
- NPI 1194175588
O20170727002043
-
dba Dewey Pharmacy
- Community/Retail Pharmacy
- Dewey, AZ
- NPI 1902445802
O20170727002043
National Provider Directory
National Provider Directory- Tax ID family
- Dewey Pharmacy
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
Locations
20172 E Stagecoach Trl
Ste A
Cordes Lakes, AZ 86333
Phone (928) 968-5040
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Chino Valley, AZ
- NPI 1801126024
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610236800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1610236800000",
"number": "1669060166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1932 N STATE ROUTE 89",
"city": "CHINO VALLEY",
"state": "AZ",
"postal_code": "863235643",
"telephone_number": "928-515-0046",
"fax_number": "928-515-0047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20172 E STAGECOACH TRL STE A",
"city": "CORDES LAKES",
"state": "AZ",
"postal_code": "863332357",
"telephone_number": "928-968-5040",
"fax_number": "928-968-5041"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTHERN ARIZONA PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-01-10",
"last_updated": "2021-01-10",
"certification_date": "2021-01-10",
"status": "A",
"authorized_official_last_name": "DYKSTRA",
"authorized_official_first_name": "JASON",
"authorized_official_middle_name": "JAMES",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "928-515-0046",
"authorized_official_credential": "PHARMD"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARIZONA STATE BOARD OF PHARMACY",
"identifier": "Y008474",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Cordes Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cordes Lakes, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2021; 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.