=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992021760
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOE ARTHUR HOOKER JR. PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2010
-----------------------------------------------------
Last Update Date | 04/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2115 HIGHWAY 60 STE 200
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85539-8744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-425-8165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 308 W MISSION DR
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85225-7196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-632-7217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835N1003X
-----------------------------------------------------
Taxonomy Name | Nutrition Support Pharmacist
-----------------------------------------------------
License Number | S017557
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------