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NPI Code Detail

MEDICARE: LISA MARIE GOMEZ

MEDICARE: LISA MARIE GOMEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistS019659AZ

General Provider Information

NPI Number : 1467891457
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE GOMEZ
Provider Business Mailing Address
First Line : 32288 N MARGARET WAY
Second Line :
City : SAN TAN VALLEY
State : AZ
Zip : 85142-6705
Country : US
Telephone Number : 602-769-1304
Fax Number :
Provider Business Practice Location Address
First Line : 2737 E MCKELLIPS RD
Second Line :
City : MESA
State : AZ
Zip : 85213-3016
Country : US
Telephone Number : 480-835-0970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2013
Last Update Date : 06/23/2013

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