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General NPI Number Information
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NPI Number | 1003466863
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Entity Type | Organization
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Legal Business Name | EMPOWERED MEDICINE
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 6788 S KINGS RANCH RD STE 1
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City | GOLD CANYON
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State | AZ
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Zip | 85118-2928
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Country | US
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Telephone | 888-600-2705
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 S. SUPERSTITION MOUNTAIN DR. SUITE 104, #155
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City | GOLD CANYON
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State | AZ
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Zip | 85118
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Country | US
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Telephone | 888-600-2705
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTI LARSON
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Credential |
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Telephone | 888-600-2705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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