Healthcare Provider Details

I. General information

NPI: 1952531949
Provider Name (Legal Business Name): MAZEN Y KHATOUN DOCTOR OF PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11203 S FRONTAGE RD
YUMA AZ
85367-7875
US

IV. Provider business mailing address

11203 S FRONTAGE RD
YUMA AZ
85367-7875
US

V. Phone/Fax

Practice location:
  • Phone: 928-342-1332
  • Fax: 928-342-1382
Mailing address:
  • Phone: 928-342-1332
  • Fax: 928-342-1382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS009587
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: