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General NPI Number Information
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NPI Number | 1245884014
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Entity Type | Individual
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Provider Name | REBECCA DODGE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 4611 E SHEA BLVD STE 180
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City | PHOENIX
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State | AZ
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Zip | 85028-4258
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Country | US
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Telephone | 612-720-2684
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Fax |
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Provider Business Mailing Address
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Address Line | 13714 W SARANO TER
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-4241
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Country | US
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Telephone | 612-720-2684
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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