Provider Demographics
NPI:1982201802
Name:PUENTE, MARCOS C (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:C
Last Name:PUENTE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 N 68TH ST.
Mailing Address - Street 2:APT #285
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85054
Mailing Address - Country:US
Mailing Address - Phone:317-514-5750
Mailing Address - Fax:
Practice Address - Street 1:1625 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3901
Practice Address - Country:US
Practice Address - Phone:602-274-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist