Individual
LIANE FOSSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7026 E ROLAND ST, MESA, AZ 85207-1280
(480) 219-4199
Mailing address
7026 E ROLAND ST, MESA, AZ 85207-1280
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S012550
AZ
Other
Enumeration date
08/26/2014
Last updated
08/26/2014
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