=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568805398
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA M MARQUEZ PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2013
-----------------------------------------------------
Last Update Date | 04/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BO CALIFORNIA CARR 3 HM117.9 BOX 262
-----------------------------------------------------
City | MAUNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00707-0262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-397-2820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 262
-----------------------------------------------------
City | MAUNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00707-0262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-397-2820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 6040
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------