Healthcare Provider Details

I. General information

NPI: 1023164464
Provider Name (Legal Business Name): ADRIJANA KEKIC PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10374 W CASHMAN DR
PEORIA AZ
85383-2634
US

IV. Provider business mailing address

10374 W CASHMAN DR
PEORIA AZ
85383-2634
US

V. Phone/Fax

Practice location:
  • Phone: 623-261-6594
  • Fax: 602-863-0015
Mailing address:
  • Phone: 623-261-6594
  • Fax: 602-863-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14339
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: