Provider Demographics
NPI:1003495177
Name:ABAD, MARIA ROSALIE G
Entity Type:Individual
Prefix:
First Name:MARIA ROSALIE
Middle Name:G
Last Name:ABAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA ROSALIE
Other - Middle Name:
Other - Last Name:ABAD-MARINAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 LAKE HAVASU AVE S
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 LAKE HAVASU AVE S
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6565
Practice Address - Country:US
Practice Address - Phone:928-453-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist