Healthcare Provider Details

I. General information

NPI: 1154657328
Provider Name (Legal Business Name): JUSTIN MICHAEL PRASNIKAR PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5771 W THUNDERBIRD RD
GLENDALE AZ
85306-4635
US

IV. Provider business mailing address

PO BOX 10355
GLENDALE AZ
85308
US

V. Phone/Fax

Practice location:
  • Phone: 602-740-6420
  • Fax:
Mailing address:
  • Phone: 602-740-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberSO14298
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: