Healthcare Provider Details

I. General information

NPI: 1285557470
Provider Name (Legal Business Name): KOOSHAN AZODI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15025 N THOMPSON PEAK PKWY
SCOTTSDALE AZ
85260-2863
US

IV. Provider business mailing address

7811 N 99TH AVE 420
GLENDALE AZ
85305
US

V. Phone/Fax

Practice location:
  • Phone: 480-551-6429
  • Fax: 480-551-7073
Mailing address:
  • Phone: 480-551-6429
  • Fax: 480-551-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI026521
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: