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Organization
AGELESS NUTRITION BAR HOLDINGS, INC
Active
Organization
AGELESS NUTRITION BAR HOLDINGS, INC
Active
Other names
Ageless Men's Health
Organization subpart
No
Provider details
NPI number
Authorized official
TEAH MICHELLE SMITH (CREDENTIALING MANAGER)
(901) 205-3999
Entity
Organization
Contact information
Practice address
4802 E RAY RD # 9, PHOENIX, AZ 85044-6405
(901) 757-3643
Mailing address
4802 E RAY RD # 9, PHOENIX, AZ 85044-6405
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
NULL
Other
Enumeration date
12/01/2020
Last updated
11/13/2023
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