Individual
GREGORY JOSEPH IMDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
9501 E SHEA BLVD # MC093, SCOTTSDALE, AZ 85260-6719
(480) 627-0605
Mailing address
3935 W ANGELA DR, GLENDALE, AZ 85308-3012
(480) 627-0605
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12203
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12203
STATE PHARMACIST LICENSE
AZ
Enumeration date
12/21/2006
Last updated
07/08/2007
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