Healthcare Provider Details

I. General information

NPI: 1366065369
Provider Name (Legal Business Name): COURTNEY ROSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY FAVAZZO

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16385 W WADDELL RD
SURPRISE AZ
85388-9623
US

IV. Provider business mailing address

6754 W ANDREA DR
PEORIA AZ
85383-6386
US

V. Phone/Fax

Practice location:
  • Phone: 602-325-1809
  • Fax: 602-325-1800
Mailing address:
  • Phone: 602-325-1809
  • Fax: 602-325-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026528
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: