Healthcare Provider Details

I. General information

NPI: 1366772550
Provider Name (Legal Business Name): KATHRYN WULBRECHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10865 N TATUM BLVD
PHOENIX AZ
85028-3055
US

IV. Provider business mailing address

10865 N TATUM BLVD
PHOENIX AZ
85028-3055
US

V. Phone/Fax

Practice location:
  • Phone: 480-922-2725
  • Fax: 480-922-2118
Mailing address:
  • Phone: 480-922-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS008934
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: