MEDICARE: MR. GARY DUFOUR

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	S007055	AZ

General Provider Information

NPI Number	:	1912225848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY DUFOUR

Provider Business Mailing Address
First Line	:	7050 E 22ND ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-5113
Country	:	US
Telephone Number	:	520-790-9492
Fax Number	:	520-747-1460

Provider Business Practice Location Address
First Line	:	7050 E 22ND ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-5113
Country	:	US
Telephone Number	:	520-790-9492
Fax Number	:	520-747-1460

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

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/17/2010

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Directions to “ MR. GARY DUFOUR ” Practice Location

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