Healthcare Provider Details

I. General information

NPI: 1538498084
Provider Name (Legal Business Name): THOMAS BEHLES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 W BELL RD
GLENDALE AZ
85308-3607
US

IV. Provider business mailing address

20720 N 55TH AVE
GLENDALE AZ
85308-9342
US

V. Phone/Fax

Practice location:
  • Phone: 623-334-2973
  • Fax:
Mailing address:
  • Phone: 623-561-8251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS011123
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: