Provider Demographics
NPI:1912225848
Name:DUFOUR, GARY
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:DUFOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-5113
Mailing Address - Country:US
Mailing Address - Phone:520-790-9492
Mailing Address - Fax:520-747-1460
Practice Address - Street 1:7050 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-5113
Practice Address - Country:US
Practice Address - Phone:520-790-9492
Practice Address - Fax:520-747-1460
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS007055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist