Healthcare Provider Details

I. General information

NPI: 1043973720
Provider Name (Legal Business Name): JOHN HAROLD VARDIAN JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18420 N 19TH AVE
PHOENIX AZ
85023-1361
US

IV. Provider business mailing address

500 S 99TH AVE
TOLLESON AZ
85353-9700
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-6610
  • Fax:
Mailing address:
  • Phone: 602-594-5035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS025502
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: