Healthcare Provider Details

I. General information

NPI: 1013247113
Provider Name (Legal Business Name): JOAN CARBAJAL-VICKHAMMER R.P.H
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 E ROSE GARDEN LN
PHOENIX AZ
85050-4264
US

IV. Provider business mailing address

4710 E ROSE GARDEN LN
PHOENIX AZ
85050-4264
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-0969
  • Fax: 480-214-0972
Mailing address:
  • Phone: 480-214-0969
  • Fax: 480-214-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8467
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: