Provider Demographics
NPI:1801531983
Name:MARA, CAROLINE (RPH)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MARA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-3412
Mailing Address - Country:US
Mailing Address - Phone:480-288-1271
Mailing Address - Fax:
Practice Address - Street 1:55 W APACHE TRL
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3412
Practice Address - Country:US
Practice Address - Phone:480-288-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36802183500000X
NE13366183500000X
ARPD10420183500000X
LAPST018420183500000X
AZS010552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist