Provider Demographics
NPI:1013317536
Name:MORTENSEN, CURTIS ARNO (PHARMD)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:ARNO
Last Name:MORTENSEN
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 1:41204 N CONGRESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1807
Mailing Address - Country:US
Mailing Address - Phone:602-903-9663
Mailing Address - Fax:
Practice Address - Street 1:3610 W ANTHEM WAY
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0416
Practice Address - Country:US
Practice Address - Phone:623-551-4299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist