MEDICARE: MARIA M DEITER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	38212	TX

General Provider Information

NPI Number	:	1457354342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA M DEITER RPH

Provider Business Mailing Address
First Line	:	180 PALMAS DR APT 1402
Second Line	:
City	:	HUMACAO
State	:	PR
Zip	:	00791-6354
Country	:	US
Telephone Number	:	956-792-2031
Fax Number	:	787-500-7377

Provider Business Practice Location Address
First Line	:	01 CARR PR-3 KM 82.5 BO. CATANO
Second Line	:	HUMACAO PLAZA
City	:	HUMACAO
State	:	PR
Zip	:	00791-4667
Country	:	US
Telephone Number	:	787-500-7377
Fax Number	:	787-741-6666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/04/2024

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