Basic Information
| Provider Information | |||||||||
| NPI: | 1417979899 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARL T. HAYDEN VA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14925 N 153RD AVE | ||||||||
| Address2: | |||||||||
| City: | SURPRISE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853797022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235449070 | ||||||||
| FaxNumber: | 6022222603 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 E. INDIAN SCHOOL ROAD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
| FaxNumber: | 6022222603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CELAYA | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | INPATIENT CLINICAL PHARMACY TECH | ||||||||
| AuthorizedOfficialTelephone: | 6022775551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPHT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | AZ | Y | Hospitals | Military Hospital |
No ID Information.