Provider Demographics
NPI:1003466863
Name:EMPOWERED MEDICINE
Entity Type:Organization
Organization Name:EMPOWERED MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-600-2705
Mailing Address - Street 1:5301 S. SUPERSTITION MOUNTAIN DR. SUITE 104, #155
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118
Mailing Address - Country:US
Mailing Address - Phone:888-600-2705
Mailing Address - Fax:
Practice Address - Street 1:6788 S KINGS RANCH RD STE 1
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-2928
Practice Address - Country:US
Practice Address - Phone:888-600-2705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty