Provider Demographics
NPI:1710395819
Name:DIAZ, MARIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:DIAZ
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 1:5872 OLD JACKSONVILLE HWY
Mailing Address - Street 2:APT 421
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8307
Practice Address - Country:US
Practice Address - Phone:903-606-8878
Practice Address - Fax:903-606-1282
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist