Healthcare Provider Details

I. General information

NPI: 1922541663
Provider Name (Legal Business Name): OLLGA AMBROGINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S 99TH AVE
TOLLESON AZ
85353-9700
US

IV. Provider business mailing address

500 S 99TH AVE
TOLLESON AZ
85353-9700
US

V. Phone/Fax

Practice location:
  • Phone: 602-594-5035
  • Fax: 602-594-5036
Mailing address:
  • Phone: 602-594-5035
  • Fax: 602-594-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022276
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: