Healthcare Provider Details

I. General information

NPI: 1629660360
Provider Name (Legal Business Name): TIFFANY GUTIERREZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28635 N NORTH VALLEY PKWY
PHOENIX AZ
85085-5434
US

IV. Provider business mailing address

25830 N 40TH PL
PHOENIX AZ
85050-9015
US

V. Phone/Fax

Practice location:
  • Phone: 623-582-9207
  • Fax:
Mailing address:
  • Phone: 602-291-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021559
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: