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General NPI Number Information
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NPI Number | 1164702205
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Entity Type | Individual
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Provider Name | SILAS MWESIGWA KIBAZO PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 08/21/2011
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Last Update Date | 08/21/2011
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Provider Practice Location Address
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Address Line | 3111 W HUNT HWY
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-9357
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Country | US
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Telephone | 480-214-2561
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Fax |
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Provider Business Mailing Address
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Address Line | 28282 N CASTLE ROCK DR
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City | QUEEN CREEK
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State | AZ
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Zip | 85143-6780
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Country | US
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Telephone | 617-240-7663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | S018662
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License Number State | AZ
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