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General NPI Number Information
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NPI Number | 1619167764
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Entity Type | Organization
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Legal Business Name | THE WOUND STORE, LLC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 10300 N SCOTTSDALE RD SUITE 11/12
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City | SCOTTSDALE
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State | AZ
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Zip | 85253-1449
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Country | US
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Telephone | 602-819-9434
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Fax | 866-453-0085
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Provider Business Mailing Address
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Address Line | PO BOX 30475
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City | MESA
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State | AZ
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Zip | 85275-0475
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Country | US
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Telephone | 602-819-9434
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Fax | 866-453-0085
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. TIMOTHY JAMES KIEBORZ
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Credential | MD
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Telephone | 602-819-9434
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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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