Individual
TONI DENISE MUCKALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, PHARMD
Contact information
Practice address
6739 W CACTUS RD, PEORIA, AZ 85381-5311
(833) 242-0100
(623) 889-0814
Mailing address
5318 E HERMOSA VISTA DR, MESA, AZ 85215-1909
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
118389
MN
363A00000X
Physician Assistant
Primary
5698
AZ
363AM0700X
Medical Physician Assistant
9530
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
388528300
—
MN
01
—
5698
STATE OF ARIZONA PA LICENSE
AZ
01
—
9530
STATE OF MINNESOTA PA LICENSE
MN
Enumeration date
01/18/2006
Last updated
10/10/2022
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