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General NPI Number Information
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NPI Number | 1174965628
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Entity Type | Individual
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Provider Name | DR. GAETAN NTEZEH NKEMZI
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Gender | Male
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 1301 W. DUVAL MINE RD
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City | SAHUARITA
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State | AZ
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Zip | 85629
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Country | US
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Telephone | 520-393-0084
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Fax |
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Provider Business Mailing Address
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Address Line | 3339 E MONTE VISTA DR APT # 12
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City | TUCSON
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State | AZ
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Zip | 85716-1964
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Country | US
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Telephone |
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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 | S019884
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License Number State | AZ
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