Individual
IAN IVANCIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1620 N 59TH AVE, PHOENIX, AZ 85035-4985
(623) 849-2092
Mailing address
1620 N 59TH AVE, PHOENIX, AZ 85035-4985
(623) 849-2092
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S020664
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S020664
PHARMACIST LICENSE
AZ
Enumeration date
07/22/2014
Last updated
07/22/2014
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