# MARICOPA COUNTY D.B.A. MARICOPA COUNTY DEPART

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARICOPA COUNTY D.B.A. MARICOPA COUNTY DEPART
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1144723495
- **Legal business name:** MARICOPA COUNTY D.B.A. MARICOPA COUNTY DEPART
- **Authorized official:** DIANE DEJONGE-RYAN MA (PROGRAM MANAGER)
- **Authorized official phone:** (602) 372-2544

## Contact information

- **Practice address:** 1645 E ROOSEVELT ST, PHOENIX, AZ 85006-3638
- **Practice address phone:** (602) 372-2544
- **Practice address fax:** (602) 372-0342
- **Mailing address:** 1645 E ROOSEVELT ST, PHOENIX, AZ 85006-3638
- **Mailing address phone:** (602) 372-2544
- **Mailing address fax:** (602) 372-0342

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1835P0018X | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | S022396 | AZ | Yes |

## Other

- **Enumeration date:** 03/13/2018
- **Last updated:** 03/13/2018