MEDICARE: DR. ISHIAH L MAREZ PHARM. D.

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	RP00006689	NM

General Provider Information

NPI Number	:	1467685685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISHIAH L MAREZ PHARM. D.

Provider Business Mailing Address
First Line	:	1625 RIO BRAVO BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-6057
Country	:	US
Telephone Number	:	505-877-3130
Fax Number	:	505-877-8072

Provider Business Practice Location Address
First Line	:	1625 RIO BRAVO BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-6057
Country	:	US
Telephone Number	:	505-877-3130
Fax Number	:	505-877-8072

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

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	09/03/2009

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