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NPI Code Detail

MEDICARE: VINCENT LIBBON JR.

MEDICARE: VINCENT LIBBON JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistAZ14043AZ

General Provider Information

NPI Number : 1003239351
Entity Type Code : Individual
Provider Name (Legal Business Name) : VINCENT LIBBON JR.
Provider Business Mailing Address
First Line : 6145 N 35TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-1940
Country : US
Telephone Number : 602-973-6561
Fax Number : 602-973-6563
Provider Business Practice Location Address
First Line : 6145 N 35TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-1940
Country : US
Telephone Number : 602-973-6561
Fax Number : 602-973-6563
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2014
Last Update Date : 01/22/2014

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