Healthcare Provider Details

I. General information

NPI: 1568762714
Provider Name (Legal Business Name): JOSEFINA UY LLAMERA-ELEMBABI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11425 W BUCKEYE RD
AVONDALE AZ
85323-6810
US

IV. Provider business mailing address

11425 W BUCKEYE RD
AVONDALE AZ
85323-6810
US

V. Phone/Fax

Practice location:
  • Phone: 623-907-6161
  • Fax:
Mailing address:
  • Phone: 623-907-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS015944
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: