Healthcare Provider Details

I. General information

NPI: 1982011177
Provider Name (Legal Business Name): GREGORY F DZIDUCH PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2014
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E THOMAS RD
PHOENIX AZ
85016-7602
US

IV. Provider business mailing address

1616 E THOMAS RD
PHOENIX AZ
85016-7602
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-8307
  • Fax:
Mailing address:
  • Phone: 585-319-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS020633
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: