Healthcare Provider Details

I. General information

NPI: 1801313945
Provider Name (Legal Business Name): NHUNG DECANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 W BUCKEYE RD
PHOENIX AZ
85043
US

IV. Provider business mailing address

8351 W MORTEN AVE
GLENDALE AZ
85305-3937
US

V. Phone/Fax

Practice location:
  • Phone: 602-442-9008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberS022747
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: