Healthcare Provider Details

I. General information

NPI: 1437532017
Provider Name (Legal Business Name): MARBEN MOPERA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 E BASELINE RD
PHOENIX AZ
85042-6801
US

IV. Provider business mailing address

2022 N NEVADA ST APT 2195
CHANDLER AZ
85225-0954
US

V. Phone/Fax

Practice location:
  • Phone: 602-276-6001
  • Fax:
Mailing address:
  • Phone: 480-246-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021216
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: