Healthcare Provider Details

I. General information

NPI: 1295010957
Provider Name (Legal Business Name): KADE ESPLIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W AGUA FRIA FWY 1141
PHOENIX AZ
85027-3929
US

IV. Provider business mailing address

2727 W AGUA FRIA FWY 1141
PHOENIX AZ
85027-3929
US

V. Phone/Fax

Practice location:
  • Phone: 623-869-7330
  • Fax:
Mailing address:
  • Phone: 623-869-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS018694
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: