Provider Demographics
NPI:1912662420
Name:TELLEZ, AIME ABIGAIL (PHARMD)
Entity Type:Individual
Prefix:
First Name:AIME
Middle Name:ABIGAIL
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4037
Mailing Address - Country:US
Mailing Address - Phone:602-866-5545
Mailing Address - Fax:
Practice Address - Street 1:3511 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4037
Practice Address - Country:US
Practice Address - Phone:602-866-5453
Practice Address - Fax:602-866-5447
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0255421835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist