Healthcare Provider Details

I. General information

NPI: 1902814395
Provider Name (Legal Business Name): TAMARA ANN CLOSE PHARM.D., BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

IV. Provider business mailing address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-1200
  • Fax:
Mailing address:
  • Phone: 602-263-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number116230-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: