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General NPI Number Information
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NPI Number | 1144723495
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Entity Type | Organization
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Legal Business Name | MARICOPA COUNTY D.B.A. MARICOPA COUNTY DEPART
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 1645 E ROOSEVELT ST
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City | PHOENIX
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State | AZ
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Zip | 85006-3638
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Country | US
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Telephone | 602-372-2544
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Fax | 602-372-0342
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Provider Business Mailing Address
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Address Line | 1645 E ROOSEVELT ST
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City | PHOENIX
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State | AZ
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Zip | 85006-3638
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Country | US
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Telephone | 602-372-2544
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Fax | 602-372-0342
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | DIANE DEJONGE-RYAN
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Credential | MA
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Telephone | 602-372-2544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | S022396
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License Number State | AZ
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