Active NPI
Fuller Selle LLC
Doing business as Trillium Specialty Hospital West Valley
- Long Term Care Pharmacy
- Sun City, AZ
National Provider Identifier
1861654964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- License
- Y004870
- Legal business name
- FULLER SELLE LLC
- Doing business as
- Trillium Specialty Hospital West Valley
- Practice address
- 13818 N Thunderbird Blvd
Sun City, AZ 85351-2574 - Phone
- (623) 977-1325
- Fax
- (623) 876-0421
- NPI assigned
- Jun 30, 2008
- 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
- Gary Alexander
- Title
- Cfo
- Phone
- (210) 745-4000
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Compounding Pharmacy | 3336C0004X | |||
| Institutional Pharmacy | 3336I0012X | |||
| Long Term Care Pharmacy | 3336L0003X | Y004870 | AZ | Primary |
Addresses
Primary practice location
13818 N Thunderbird Blvd
Sun City, AZ 85351-2574
Mailing address
777 Esoriterra Blvd
Ste 300
San Antonio, TX 78258
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0355380 | Other | OTHER ID NUMBER |
Other names 1
- TRILLIUM SPECIALTY HOSPITAL WEST VALLEY
National Provider Directory
National Provider Directory- Tax ID family
- Fuller Selle LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Trillium Specialty Hospital East Valley
- Long Term Care Pharmacy
- Mesa, AZ
- NPI 1053573154
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214784000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1214784000000",
"number": "1861654964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "777 ESORITERRA BLVD",
"address_2": "STE 300",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13818 N THUNDERBIRD BLVD",
"city": "SUN CITY",
"state": "AZ",
"postal_code": "853512574",
"telephone_number": "623-977-1325",
"fax_number": "623-876-0421"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FULLER SELLE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-06-30",
"last_updated": "2008-06-30",
"status": "A",
"authorized_official_last_name": "ALEXANDER",
"authorized_official_first_name": "GARY",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "210-745-4000"
},
"taxonomies": [
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336I0012X",
"taxonomy_group": "",
"desc": "Pharmacy, Institutional Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": "AZ",
"license": "Y004870",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER",
"identifier": "0355380",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "TRILLIUM SPECIALTY HOSPITAL WEST VALLEY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Sun City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.