Healthcare Provider Details

I. General information

NPI: 1396264289
Provider Name (Legal Business Name): MERCEDES MALTBIE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 SOUTH POWER ROAD
MESA AZ
85206
US

IV. Provider business mailing address

1915 S POWER RD
MESA AZ
85206-4301
US

V. Phone/Fax

Practice location:
  • Phone: 480-924-0868
  • Fax:
Mailing address:
  • Phone: 480-924-0868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022859
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: