Provider Demographics
NPI:1013202480
Name:MAGSAM, GRETCHEN A (PHARMD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:A
Last Name:MAGSAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:A
Other - Last Name:HAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10641 W OLIVE AVE
Mailing Address - Street 2:1662
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7323
Mailing Address - Country:US
Mailing Address - Phone:623-583-6688
Mailing Address - Fax:
Practice Address - Street 1:10641 W OLIVE AVE
Practice Address - Street 2:1662
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7323
Practice Address - Country:US
Practice Address - Phone:623-583-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist