Healthcare Provider Details

I. General information

NPI: 1356705164
Provider Name (Legal Business Name): LOUY AL ATTEELI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10503 W THUNDERBIRD BLVD STE 101B
SUN CITY AZ
85351-2719
US

IV. Provider business mailing address

3502 W CAMELBACK RD
PHOENIX AZ
85019-2707
US

V. Phone/Fax

Practice location:
  • Phone: 623-974-3555
  • Fax: 623-875-0777
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021151
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: