MEDICARE: DR. SILAS MWESIGWA KIBAZO PHARM.D

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
1	183500000X	Pharmacist	S018662	AZ

General Provider Information

NPI Number	:	1164702205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SILAS MWESIGWA KIBAZO PHARM.D

Provider Business Mailing Address
First Line	:	28282 N CASTLE ROCK DR
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85143-6780
Country	:	US
Telephone Number	:	617-240-7663
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 W HUNT HWY
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-9357
Country	:	US
Telephone Number	:	480-214-2561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2011
Last Update Date	:	08/21/2011

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