Provider Demographics
NPI:1033510235
Name:BUSTAMANTE, PATRICIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 N SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5415
Mailing Address - Country:US
Mailing Address - Phone:480-822-6197
Mailing Address - Fax:480-991-9685
Practice Address - Street 1:6200 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-5415
Practice Address - Country:US
Practice Address - Phone:480-822-6197
Practice Address - Fax:480-991-9685
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS009764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist