Provider Demographics
NPI:1841502010
Name:STOCK, VIVIAN (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:STOCK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3034 E AGRITOPIA LOOP N
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-7819
Mailing Address - Country:US
Mailing Address - Phone:623-341-3412
Mailing Address - Fax:
Practice Address - Street 1:6951 S KINGS RANCH RD
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-3012
Practice Address - Country:US
Practice Address - Phone:480-288-7208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist