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General NPI Number Information
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NPI Number | 1669147823
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Entity Type | Individual
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Provider Name | JENNFIER KONDOS
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Gender | Female
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 4500 E COTTON CENTER BLVD
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City | PHOENIX
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State | AZ
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Zip | 85040-8840
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Country | US
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Telephone | 860-900-4835
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Fax |
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Provider Business Mailing Address
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Address Line | 7751 E GLENROSA AVE APT C1
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-4034
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Country | US
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Telephone | 701-833-5385
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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 | S025132
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License Number State | AZ
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