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General NPI Number Information
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NPI Number | 1639627615
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Entity Type | Individual
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Provider Name | MANUEL MAKSUMOV PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 5421 W THUNDERBIRD RD
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City | GLENDALE
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State | AZ
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Zip | 85306-4751
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Country | US
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Telephone | 602-547-9645
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Fax |
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Provider Business Mailing Address
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Address Line | 16224 N 7TH LN
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City | PHOENIX
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State | AZ
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Zip | 85023-3599
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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 | S022055
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License Number State | AZ
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