Healthcare Provider Details

I. General information

NPI: 1972438026
Provider Name (Legal Business Name): KELLY FRIBOURG PHARM.D.
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: KELLY MARIE BROWN PHARM.D.

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 S RIVER PKWY
TEMPE AZ
85284-2615
US

IV. Provider business mailing address

8350 S RIVER PKWY
TEMPE AZ
85284-2615
US

V. Phone/Fax

Practice location:
  • Phone: 800-345-1036
  • Fax:
Mailing address:
  • Phone: 800-345-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57462
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45200
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: