Healthcare Provider Details

I. General information

NPI: 1871971721
Provider Name (Legal Business Name): AMARA GUDGER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 N DYSART RD
AVONDALE AZ
85323-1515
US

IV. Provider business mailing address

1459 N DYSART RD
AVONDALE AZ
85323-1515
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-3871
  • Fax:
Mailing address:
  • Phone: 623-882-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021123
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: