Provider Demographics
NPI:1083253330
Name:DANIEL-RZAYEV, MARY ATOUR
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ATOUR
Last Name:DANIEL-RZAYEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 E CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-5262
Mailing Address - Country:US
Mailing Address - Phone:480-332-8343
Mailing Address - Fax:
Practice Address - Street 1:41650 W MARICOPA CASA GRANDE HWY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-3206
Practice Address - Country:US
Practice Address - Phone:520-568-0846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist