Provider Demographics
NPI:1447242417
Name:CIGNA HEALTH CARE OF ARIZONA INC
Entity type:Organization
Organization Name:CIGNA HEALTH CARE OF ARIZONA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST, SR. MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:KORB
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD, BCACP
Authorized Official - Phone:480-769-2513
Mailing Address - Street 1:8888 E RAINTREE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3968
Mailing Address - Country:US
Mailing Address - Phone:602-328-8400
Mailing Address - Fax:623-877-1091
Practice Address - Street 1:1920 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1511
Practice Address - Country:US
Practice Address - Phone:480-345-5319
Practice Address - Fax:480-345-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336M0003X
AZ17043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1988691OtherPK