Individual
IVY MAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
2406 E THOMAS RD, PHOENIX, AZ 85016-7912
(602) 956-3580
Mailing address
2406 E THOMAS RD, PHOENIX, AZ 85016-7912
(602) 956-3580
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S026155
AZ
Other
Enumeration date
10/12/2022
Last updated
10/12/2022
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