Provider Demographics
NPI:1659874113
Name:FERREIRO, MARIAMME
Entity Type:Individual
Prefix:
First Name:MARIAMME
Middle Name:
Last Name:FERREIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIAMME
Other - Middle Name:
Other - Last Name:KOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 HIGHWAY 78 STE 230
Mailing Address - Street 2:
Mailing Address - City:LAVON
Mailing Address - State:TX
Mailing Address - Zip Code:75166-1266
Mailing Address - Country:US
Mailing Address - Phone:972-843-7010
Mailing Address - Fax:
Practice Address - Street 1:440 HIGHWAY 78 STE 230
Practice Address - Street 2:
Practice Address - City:LAVON
Practice Address - State:TX
Practice Address - Zip Code:75166-1266
Practice Address - Country:US
Practice Address - Phone:972-843-7010
Practice Address - Fax:972-674-2919
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist