Individual
LENORE JANIS VANDERGRIEND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
24565 N 78TH AVE, PEORIA, AZ 85383-1628
(330) 518-6278
Mailing address
24565 N 78TH AVE, PEORIA, AZ 85383-1628
(330) 518-6278
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
T073999
AZ
Other
Enumeration date
12/19/2021
Last updated
12/19/2021
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