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NPI Code Detail

MEDICARE: TARGET

MEDICARE: TARGET
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
1261QC1500XCommunity Health Clinic/CenterS011164AZ

General Provider Information

NPI Number : 1487050589
Entity Type Code : Organization
Provider Name (Legal Business Name) : TARGET
Provider Business Mailing Address
First Line : 4732 E RAY RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85044
Country : US
Telephone Number : 480-893-0588
Fax Number :
Provider Business Practice Location Address
First Line : 4734 E RAY RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-6225
Country : US
Telephone Number : 480-893-0588
Fax Number :
Authorized Official
Title or Position : ETL RX
Name : DR. KATHERINE STEIN
Credential : PHARMD
Telephone Number : 480-893-0588
Provider Enumeration Date : 11/17/2014
Last Update Date : 11/17/2014

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Directions to “TARGET ” Practice Location

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