Provider Demographics
NPI:1245790617
Name:BOOKER, GAYE YAVON (RPH)
Entity Type:Individual
Prefix:MS
First Name:GAYE
Middle Name:YAVON
Last Name:BOOKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10916 W ASHBROOK PL
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-3710
Mailing Address - Country:US
Mailing Address - Phone:314-623-3945
Mailing Address - Fax:602-788-4805
Practice Address - Street 1:3210 E UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3223
Practice Address - Country:US
Practice Address - Phone:602-788-4793
Practice Address - Fax:602-788-4805
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist