Individual
JACKIE TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 S 99TH AVE, TOLLESON, AZ 85353-9700
(623) 907-4933
Mailing address
500 S 99TH AVE, TOLLESON, AZ 85353-9700
(623) 907-4933
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S027250
AZ
Other
Enumeration date
09/17/2021
Last updated
09/17/2024
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