Individual
MRS. KELLY M JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5324 E WASHINGTON ST, PHOENIX, AZ 85034-2144
(602) 732-3384
Mailing address
29774 N 69TH AVE, PEORIA, AZ 85383-3173
(219) 808-0293
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
26020635A
IN
183500000X
Pharmacist
Primary
S017785
AZ
Other
Enumeration date
08/24/2010
Last updated
04/11/2019
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