MEDICARE: DR. ASHLEE CAITLIN BUMGUARDNER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S024074	AZ

General Provider Information

NPI Number	:	1154953537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEE CAITLIN BUMGUARDNER PHARMD

Provider Business Mailing Address
First Line	:	4625 W PARK PL
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-1513
Country	:	US
Telephone Number	:	928-660-9287
Fax Number	:

Provider Business Practice Location Address
First Line	:	5895 W PEORIA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-1303
Country	:	US
Telephone Number	:	623-934-9152
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2020
Last Update Date	:	02/04/2020

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