Basic Information
| Provider Information | |||||||||
| NPI: | 1063413524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGHA | ||||||||
| FirstName: | AHMED | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D., PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3124 WILLOW CREEK RD | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863016610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284457085 | ||||||||
| FaxNumber: | 9284457095 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 W BETHANY HOME RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850152443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022465658 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 01/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 58031 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine | 183500000X | 03-2-22901 | OH | N | Pharmacy Service Providers | Pharmacist |
No ID Information.