Healthcare Provider Details

I. General information

NPI: 1306092085
Provider Name (Legal Business Name): ELIZABETH KATHRYN POGGE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19555 N 59TH AVE MWU-CPG
GLENDALE AZ
85308-6813
US

IV. Provider business mailing address

19555 N 59TH AVE MWU-CPG
GLENDALE AZ
85308-6813
US

V. Phone/Fax

Practice location:
  • Phone: 623-572-3579
  • Fax: 623-572-3550
Mailing address:
  • Phone: 623-572-3579
  • Fax: 623-572-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16651
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: