Provider Demographics
NPI:1891379616
Name:DISHO ANDRADA, MARIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:DISHO ANDRADA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13705 POINSETTIA CT SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-3955
Mailing Address - Country:US
Mailing Address - Phone:916-367-8835
Mailing Address - Fax:
Practice Address - Street 1:2266 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2620
Practice Address - Country:US
Practice Address - Phone:505-323-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist