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NPI Code Detail

MEDICARE: JOAN CARBAJAL-VICKHAMMER R.P.H

MEDICARE: JOAN CARBAJAL-VICKHAMMER R.P.H
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
1183500000XPharmacist8467AZ

General Provider Information

NPI Number : 1013247113
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOAN CARBAJAL-VICKHAMMER R.P.H
Provider Business Mailing Address
First Line : 4710 E ROSE GARDEN LN
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4264
Country : US
Telephone Number : 480-214-0969
Fax Number : 480-214-0972
Provider Business Practice Location Address
First Line : 4710 E ROSE GARDEN LN
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4264
Country : US
Telephone Number : 480-214-0969
Fax Number : 480-214-0972
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2010
Last Update Date : 01/12/2010

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