Individual
ALI LOIS ICENOGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMACIST
Contact information
Practice address
3601 S 6TH AVE, TUCSON, AZ 85723-1532
(520) 792-1450
Mailing address
2501 W ORANGE GROVE RD UNIT 66, TUCSON, AZ 85741-3417
(480) 789-9151
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH61056519
WA
Other
Enumeration date
11/13/2017
Last updated
09/29/2021
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