Healthcare Provider Details

I. General information

NPI: 1831700814
Provider Name (Legal Business Name): MAKENNA URAINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 S SOSSAMAN RD
MESA AZ
85209-3400
US

IV. Provider business mailing address

45 E 9TH PL UNIT 75
MESA AZ
85201-4339
US

V. Phone/Fax

Practice location:
  • Phone: 480-333-6550
  • Fax:
Mailing address:
  • Phone: 951-515-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS024715
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: