Healthcare Provider Details

I. General information

NPI: 1508547597
Provider Name (Legal Business Name): MARQUIAH IMANI LADD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 E SHEA BLVD
PHOENIX AZ
85028-4215
US

IV. Provider business mailing address

16220 N 7TH ST APT 3412
PHOENIX AZ
85022-6678
US

V. Phone/Fax

Practice location:
  • Phone: 480-367-3973
  • Fax:
Mailing address:
  • Phone: 503-841-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026511
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: