Provider Demographics
NPI:1477871614
Name:TOMBAZIAN, ANDREA R (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:TOMBAZIAN
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 1:8884 E PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7608
Mailing Address - Country:US
Mailing Address - Phone:480-657-6433
Mailing Address - Fax:480-657-6427
Practice Address - Street 1:8900 E VIA LINDA
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5404
Practice Address - Country:US
Practice Address - Phone:480-657-6433
Practice Address - Fax:480-657-6427
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist