Provider Demographics
NPI:1659652592
Name:PEHLING, MARY P
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:PEHLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10135 E VIA LINDA
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5328
Mailing Address - Country:US
Mailing Address - Phone:480-391-3769
Mailing Address - Fax:480-391-2497
Practice Address - Street 1:10135 E VIA LINDA
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5328
Practice Address - Country:US
Practice Address - Phone:480-391-3769
Practice Address - Fax:480-391-2497
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist