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General NPI Number Information
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NPI Number | 1487101028
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Entity Type | Individual
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Provider Name | MARISOL IBARRA
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Gender | Female
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 4802 N 12TH ST APT 1086
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City | PHOENIX
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State | AZ
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Zip | 85014-4098
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Country | US
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Telephone | 915-504-9507
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 N CENTRAL AVE STE 160
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City | PHOENIX
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State | AZ
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Zip | 85012
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Country | US
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Telephone | 915-504-9507
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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 | 28RI03759900
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License Number State | NJ
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