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General NPI Number Information
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NPI Number | 1447479050
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Entity Type | Individual
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Provider Name | RICK R MASCARENAS R.PH.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 1610 N RIVERSIDE DR
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City | ESPANOLA
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State | NM
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Zip | 87532-8063
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Country | US
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Telephone | 505-852-4280
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1180 RANCHO SAN GABRIEL
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City | SAN JUAN PUEBLO
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State | NM
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Zip | 87566-1180
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Country | US
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Telephone | 505-852-4280
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Fax | 505-747-0429
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 4471
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License Number State | NM
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