Healthcare Provider Details

I. General information

NPI: 1538880216
Provider Name (Legal Business Name): KRISTOPHER CARSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W BELL RD
PHOENIX AZ
85053-3059
US

IV. Provider business mailing address

15050 N 8TH AVE
PHOENIX AZ
85023-5215
US

V. Phone/Fax

Practice location:
  • Phone: 602-896-2533
  • Fax:
Mailing address:
  • Phone: 602-403-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026043
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: