Healthcare Provider Details

I. General information

NPI: 1235625989
Provider Name (Legal Business Name): MARINA LISA MAES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 ROSLYN ST
DENVER CO
80238-3323
US

IV. Provider business mailing address

13243 CLERMONT CIR
THORNTON CO
80241-1539
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-9000
  • Fax:
Mailing address:
  • Phone: 720-202-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0021815
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: