Maryvale Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

Y002881 Issued in AZ

Legal business name

MARYVALE PHARMACY INC

Doing business as

M D Pharmacy

Practice address

4700 N 51St Ave Ste 1
Phoenix, AZ 85031-1237

Phone

(623) 846-1888

Fax

(623) 848-8202

NPI assigned

Aug 10, 2006

Last updated

Jun 8, 2016By 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

Richard Bates, BS CHE BSPHARM

Title

Owner

Phone

(623) 846-1888

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• M D PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465344000000",
    "number": "1669483236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 N 51ST AVE STE 1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850311237",
            "telephone_number": "623-846-1888",
            "fax_number": "623-848-8202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 N 51ST AVE STE 1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850311237",
            "telephone_number": "623-846-1888",
            "fax_number": "623-848-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYVALE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2016-06-08",
        "status": "A",
        "authorized_official_last_name": "BATES",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-846-1888",
        "authorized_official_credential": "BS CHE BSPHARM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y002881",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "380379",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1997277",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "M D PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Anissa Marzuki, PHARM.D.

• 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 Jun 8, 2016; 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.