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General NPI Number Information
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NPI Number | 1215355813
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Entity Type | Individual
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Provider Name | MARIO WILMATH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 3601 S 6TH AVE
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City | TUCSON
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State | AZ
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Zip | 85723-0001
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Country | US
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Telephone | 520-629-1450
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 E 4TH ST APT 18
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City | TUCSON
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State | AZ
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Zip | 85716-5054
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Country | US
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Telephone | 505-737-9126
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PS51561
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS5161
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License Number State | FL
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