Provider Demographics
NPI:1720789365
Name:MARQUEZ, MICHELE L (PHARMACY TECH)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32450 CLINTON KEITH RD
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7312
Mailing Address - Country:US
Mailing Address - Phone:951-678-9141
Mailing Address - Fax:951-678-0614
Practice Address - Street 1:32450 CLINTON KEITH RD
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7312
Practice Address - Country:US
Practice Address - Phone:951-678-9141
Practice Address - Fax:951-678-0614
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57729183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician