Healthcare Provider Details

I. General information

NPI: 1891073011
Provider Name (Legal Business Name): PALO VERDE HEMATOLOGY ONCOLOGY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 W. THOMAS RD. #150
PHOENIX AZ
85037
US

IV. Provider business mailing address

5601 W EUGIE AVE #106
GLENDALE AZ
85304-1255
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-6255
  • Fax: 623-478-8423
Mailing address:
  • Phone: 602-978-6255
  • Fax: 602-644-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number24284
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number14106
License Number StateAZ

VIII. Authorized Official

Name: MR. HAIDER ZAFAR
Title or Position: PHYSICIAN/SHAREHOLDER
Credential: M.D.
Phone: 602-978-6255