Healthcare Provider Details

I. General information

NPI: 1063724318
Provider Name (Legal Business Name): RAYMOND A LABRECQUE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 E THOMAS RD
PHOENIX AZ
85018-7614
US

IV. Provider business mailing address

1625 W CAMELBACK RD
PHOENIX AZ
85015-3524
US

V. Phone/Fax

Practice location:
  • Phone: 602-952-1491
  • Fax: 602-952-9310
Mailing address:
  • Phone: 602-264-4820
  • Fax: 602-200-9837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12886
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS012886
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: