Provider Demographics
NPI:1871700435
Name:ANAZAOHEALTH CORPORATION
Entity type:Organization
Organization Name:ANAZAOHEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-995-4363
Mailing Address - Street 1:5710 HOOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5339
Mailing Address - Country:US
Mailing Address - Phone:800-995-4363
Mailing Address - Fax:800-985-4363
Practice Address - Street 1:6630 W ARBY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4682
Practice Address - Country:US
Practice Address - Phone:702-873-8455
Practice Address - Fax:702-873-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH014713336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPH01471OtherPHARMACY LICENSE