Healthcare Provider Details

I. General information

NPI: 1861738791
Provider Name (Legal Business Name): JOHN DENIS GUZZETTA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N SWITZER CANYON DR
FLAGSTAFF AZ
86001-4836
US

IV. Provider business mailing address

486 W CATTLE DRIVE TRL
FLAGSTAFF AZ
86001-6953
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-3389
  • Fax: 928-774-8554
Mailing address:
  • Phone: 602-769-6636
  • Fax: 928-774-8554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number006875
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: