MEDICARE: MARK HOFFMAN PHARMD

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	S024337	AZ

General Provider Information

NPI Number	:	1215564273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK HOFFMAN PHARMD

Provider Business Mailing Address
First Line	:	5419 N 80TH LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-5517
Country	:	US
Telephone Number	:	623-332-1558
Fax Number	:

Provider Business Practice Location Address
First Line	:	5419 N 80TH LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-5517
Country	:	US
Telephone Number	:	623-332-1558
Fax Number	:

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

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	03/26/2020

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