Healthcare Provider Details

I. General information

NPI: 1982201802
Provider Name (Legal Business Name): MARCOS C. PUENTE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 10/04/2020
Certification Date: 10/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 E CAMELBACK RD
PHOENIX AZ
85016-3901
US

IV. Provider business mailing address

18220 N 68TH ST. APT #285
SCOTTSDALE AZ
85054
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-0810
  • Fax:
Mailing address:
  • Phone: 317-514-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS024937
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: