Provider Demographics
NPI:1861047409
Name:BORHAUER, ATHENA LEAH (PHARMD)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:LEAH
Last Name:BORHAUER
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 1:800 S CARMICHAEL AVE APT 211
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-3092
Mailing Address - Country:US
Mailing Address - Phone:480-444-6319
Mailing Address - Fax:
Practice Address - Street 1:2090 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2707
Practice Address - Country:US
Practice Address - Phone:520-458-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist