Provider Demographics
NPI:1609384007
Name:SMITH BURGOS, TONI (RPH)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:SMITH BURGOS
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 1:3385 CALLE DEL SOL
Mailing Address - Street 2:11
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336
Mailing Address - Country:US
Mailing Address - Phone:765-273-8247
Mailing Address - Fax:
Practice Address - Street 1:7720 E HWY 69
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-772-6126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist