Provider Demographics
NPI:1508378092
Name:SOMERA, MARIDEL
Entity Type:Individual
Prefix:
First Name:MARIDEL
Middle Name:
Last Name:SOMERA
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:PO BOX 20156
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921-0156
Mailing Address - Country:US
Mailing Address - Phone:671-637-6806
Mailing Address - Fax:
Practice Address - Street 1:138 KAYEN CHANDO
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5900
Practice Address - Country:US
Practice Address - Phone:671-632-8100
Practice Address - Fax:671-922-3000
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPH0260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist