Camille Agosto de Jesus
Individual provider Active NPI Pharmacist · Tolleson, AZ
NPI 1730620667 · NPPES record last updated Mar 10, 2017
Key facts
- NPI
- 1730620667
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- S022363 (AZ)
- Practice address
- 500 S 99TH Ave
Tolleson, AZ 85353-9700 - Phone
- (623) 936-2442
- NPI assigned
- Mar 10, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S022363 | AZ | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S022363 | AZ | Yes |
Addresses
Primary practice location
500 S 99TH Ave
Tolleson, AZ 85353-9700
Mailing address
500 S 99TH Ave
Tolleson, AZ 85353-9700
Other providers in Tolleson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.