Healthcare Provider Details

I. General information

NPI: 1265396477
Provider Name (Legal Business Name): GINA VICTOR FARID MOFTAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5733 N CAMINO DE LAS ESTRELLAS
TUCSON AZ
85718-4424
US

IV. Provider business mailing address

5733 N CAMINO DE LAS ESTRELLAS
TUCSON AZ
85718-4424
US

V. Phone/Fax

Practice location:
  • Phone: 480-431-5170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS025008
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68436
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH87652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: