Individual
NGOC NGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
1415 N ARIZONA AVE, GILBERT, AZ 85233-1616
(480) 293-0052
Mailing address
1415 N ARIZONA AVE, GILBERT, AZ 85233-1616
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S010181
AZ
Other
Enumeration date
05/26/2021
Last updated
05/26/2021
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