Provider Demographics
NPI:1760782486
Name:FOGGATT, CARSTEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARSTEN
Middle Name:
Last Name:FOGGATT
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 1:1960 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6914
Mailing Address - Country:US
Mailing Address - Phone:480-644-8873
Mailing Address - Fax:480-644-9598
Practice Address - Street 1:1960 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6914
Practice Address - Country:US
Practice Address - Phone:480-644-8873
Practice Address - Fax:480-644-9598
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist