Healthcare Provider Details

I. General information

NPI: 1245545649
Provider Name (Legal Business Name): MRS. GRETCHEN M AMOROSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 E THUNDERBIRD RD
PHOENIX AZ
85032-5836
US

IV. Provider business mailing address

4779 E AGAVE LN
CAVE CREEK AZ
85331-4709
US

V. Phone/Fax

Practice location:
  • Phone: 602-953-3540
  • Fax:
Mailing address:
  • Phone: 602-369-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberS011272
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS011272
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: