Provider Demographics
NPI:1053521245
Name:CIGNA HEALTHCAREOF AZ, INC.
Entity type:Organization
Organization Name:CIGNA HEALTHCAREOF AZ, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY AREA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARJU
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:623-277-1168
Mailing Address - Street 1:25500 N NORTERRA DR
Mailing Address - Street 2:ATTN: PHARMACY ADMINISTRATION
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8200
Mailing Address - Country:US
Mailing Address - Phone:623-277-1168
Mailing Address - Fax:623-277-1023
Practice Address - Street 1:9014 N 23RD AVE
Practice Address - Street 2:SUITE 14 & 15
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2853
Practice Address - Country:US
Practice Address - Phone:602-216-6630
Practice Address - Fax:602-216-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0326428333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0326428OtherNABP NUMBER