Healthcare Provider Details

I. General information

NPI: 1760782486
Provider Name (Legal Business Name): CARSTEN FOGGATT PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 W MAIN ST
MESA AZ
85201-6914
US

IV. Provider business mailing address

1960 W MAIN ST
MESA AZ
85201-6914
US

V. Phone/Fax

Practice location:
  • Phone: 480-644-8873
  • Fax: 480-644-9598
Mailing address:
  • Phone: 480-644-8873
  • Fax: 480-644-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS016109
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: