Individual
KISA KISAKYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10727 W OLIVE AVE, PEORIA, AZ 85345-9202
(623) 815-8074
Mailing address
4530 W MCLELLAN RD, GLENDALE, AZ 85301-4211
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
S014292
AZ
Other
Enumeration date
12/27/2021
Last updated
12/27/2021
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