Healthcare Provider Details

I. General information

NPI: 1942559570
Provider Name (Legal Business Name): RACHEL ADHIAMBO OGUMBO PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E GRANT RD
TUCSON AZ
85705
US

IV. Provider business mailing address

555 E GRANT RD
TUCSON AZ
85705
US

V. Phone/Fax

Practice location:
  • Phone: 520-628-9428
  • Fax:
Mailing address:
  • Phone: 520-628-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS019220
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: