Provider Demographics
NPI:1508278631
Name:LOFGREN, MARY ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:LOFGREN
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 1:1000 E BENRICH DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8351
Mailing Address - Country:US
Mailing Address - Phone:480-807-0251
Mailing Address - Fax:480-832-5379
Practice Address - Street 1:1000 E BENRICH DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8351
Practice Address - Country:US
Practice Address - Phone:480-807-0251
Practice Address - Fax:480-832-5379
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist