Provider Demographics
NPI:1508547597
Name:LADD, MARQUIAH IMANI (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARQUIAH
Middle Name:IMANI
Last Name:LADD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16220 N 7TH ST APT 3412
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-6678
Mailing Address - Country:US
Mailing Address - Phone:503-841-0970
Mailing Address - Fax:
Practice Address - Street 1:4315 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3530
Practice Address - Country:US
Practice Address - Phone:602-938-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist