Organization
AGELESS NUTRITION BAR HOLDINGS, INC
Active
Other names
Ageless Men's Health
Organization subpart
No
Provider details
NPI number
Authorized official
TEAH MICHELLE SMITH (CREDENTIALING MANAGER)
(901) 205-3999
Entity
Organization
Contact information
Practice address
4802 E RAY RD # 9, PHOENIX, AZ 85044-6405
(901) 757-3643
Mailing address
4802 E RAY RD # 9, PHOENIX, AZ 85044-6405
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
12/01/2020
Last updated
11/13/2023
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