Organization
THE WOUND STORE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY JAMES KIEBORZ MD (CEO/OWNER)
(602) 819-9434
Entity
Organization
Contact information
Practice address
10300 N SCOTTSDALE RD, SUITE 11/12, SCOTTSDALE, AZ 85253-1449
(602) 819-9434
(866) 453-0085
Mailing address
PO BOX 30475, MESA, AZ 85275-0475
(602) 819-9434
(866) 453-0085
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y004798
STATE PHARMACY LICENSE
AZ
Enumeration date
07/25/2007
Last updated
03/07/2023
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