Provider Demographics
NPI:1245545649
Name:AMOROSO, GRETCHEN M
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:M
Last Name:AMOROSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4779 E AGAVE LN
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-4709
Mailing Address - Country:US
Mailing Address - Phone:602-369-9580
Mailing Address - Fax:
Practice Address - Street 1:4025 E THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5836
Practice Address - Country:US
Practice Address - Phone:602-953-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist