MEDICARE: VERA RADWAN

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	S026954	AZ

General Provider Information

NPI Number	:	1356199111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERA RADWAN

Provider Business Mailing Address
First Line	:	4760 E BASELINE RD APT 2094
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4690
Country	:	US
Telephone Number	:	480-803-1567
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 E RAY RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-1599
Country	:	US
Telephone Number	:	480-917-3041
Fax Number	:

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

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/08/2024

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Directions to “ VERA RADWAN ” Practice Location

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