Healthcare Provider Details

I. General information

NPI: 1801531983
Provider Name (Legal Business Name): CAROLINE MARA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 W APACHE TRL
APACHE JUNCTION AZ
85120-3412
US

IV. Provider business mailing address

55 W APACHE TRL
APACHE JUNCTION AZ
85120-3412
US

V. Phone/Fax

Practice location:
  • Phone: 480-288-1271
  • Fax:
Mailing address:
  • Phone: 480-288-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS36802
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13366
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10420
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST018420
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS010552
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: