Northern Arizona Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

NORTHERN ARIZONA PHARMACY LLC

Practice address

12075 E State Route 69
Suite E
Dewey, AZ 86327

Phone

(928) 515-0455

Fax

(928) 515-0456

NPI assigned

Dec 26, 2019

Organization subpart

No

Name

Dr. Jason James Dykstra, PHARMD

Title

Manager

Phone

(928) 515-0046

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Northern Arizona Pharmacy LLC

  • Pharmacy
  • Chino Valley, AZ
  • NPI 1194175588

  O20170727002043

  Same enrollment
• Northern Arizona Pharmacy LLC

  • Community/Retail Pharmacy
  • Cordes Lakes, AZ
  • NPI 1669060166

  O20170727002043

  Same enrollment

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Tax ID family

Dewey Pharmacy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Northern Arizona Pharmacy

  • Long Term Care Pharmacy
  • Dewey, AZ
  • NPI 1932830205
  NPD tax ID
• Northern Arizona Pharmacy LLC

  • Pharmacy
  • Chino Valley, AZ
  • NPI 1194175588
  NPD tax ID
• Northern Arizona Pharmacy LLC

  • Community/Retail Pharmacy
  • Cordes Lakes, AZ
  • NPI 1669060166
  NPD tax ID

Locations

• Dewey Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 8, 2020.

{
    "created_epoch": "1577318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607385600000",
    "number": "1902445802",
    "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": "12075 E STATE ROUTE 69",
            "address_2": "SUITE E",
            "city": "DEWEY",
            "state": "AZ",
            "postal_code": "86327",
            "telephone_number": "928-515-0455",
            "fax_number": "928-515-0456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12075 E State Route 89",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Prescott Valley",
            "state": "AZ",
            "postal_code": "86314",
            "country_code": "US",
            "telephone_number": "928-515-0046",
            "fax_number": "928-515-0047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHERN ARIZONA PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-26",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "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_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003672",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dewey Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dewey Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Monreal Family Services, LLC
• Toni L Monreal, LCSW
• Keri Newberry
• Cindy Kay Noble
• Northern Arizona Pharmacy
• Candace Oen, P. A. -C.
• Frederic Leland Ondovchak, R.N., M.S.N., A.P.R.
• Angela Payne, LPN
• Prescott Renal Care Group, LLC
• Quad City Medical Associate, LLC

• All providers in Dewey, AZ
• Community/Retail Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; 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.

Verify at the official NPI Registry.