Healthcare Provider Details

I. General information

NPI: 1710690045
Provider Name (Legal Business Name): JENNA DODT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 W BASELINE RD
MESA AZ
85210-6019
US

IV. Provider business mailing address

2646 E HOPI AVE
MESA AZ
85204-6264
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-6234
  • Fax:
Mailing address:
  • Phone: 480-784-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026251
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: