Provider Demographics
NPI:1336474238
Name:PROMBERGER, JAMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:PROMBERGER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 E SAHUARO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3443
Mailing Address - Country:US
Mailing Address - Phone:602-867-4060
Mailing Address - Fax:602-867-2594
Practice Address - Street 1:4842 E BELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6005
Practice Address - Country:US
Practice Address - Phone:620-867-4060
Practice Address - Fax:602-867-2594
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSO13210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist