Healthcare Provider Details

I. General information

NPI: 1013809128
Provider Name (Legal Business Name): ALYSSA HENGLEFELT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10460 N 92ND ST STE 305
SCOTTSDALE AZ
85258-4548
US

IV. Provider business mailing address

PO BOX 72567
PHOENIX AZ
85050-1027
US

V. Phone/Fax

Practice location:
  • Phone: 480-583-5603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberS021925
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: