Healthcare Provider Details

I. General information

NPI: 1508782319
Provider Name (Legal Business Name): ARIELLE JOLIE DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13227 N 7TH ST
PHOENIX AZ
85022-5303
US

IV. Provider business mailing address

20000 N 57TH AVE RM E205
GLENDALE AZ
85308-6860
US

V. Phone/Fax

Practice location:
  • Phone: 602-439-4089
  • Fax:
Mailing address:
  • Phone: 347-522-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS027959
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: