Healthcare Provider Details

I. General information

NPI: 1831546936
Provider Name (Legal Business Name): HONORHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3648 W ANTHEM WAY A-100
ANTHEM AZ
85086-7001
US

IV. Provider business mailing address

3648 W ANTHEM WAY A-100
ANTHEM AZ
85086
US

V. Phone/Fax

Practice location:
  • Phone: 623-434-6467
  • Fax:
Mailing address:
  • Phone: 623-434-6467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number13446
License Number StateAZ

VIII. Authorized Official

Name: TAMMY WILSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 623-434-6467